11/53. The peritoneal route as a safe pathway for early in utero therapies: illustration by a 12-year follow-up after conservative management of severe Rhesus allo-immunization.OBJECTIVE: We report a case of an extremely severe Rhesus allo-immunization treated very early in pregnancy 12 years ago. methods AND RESULTS: After chorionic villus sampling at 12 weeks for fetal blood phenotyping, two intraperitoneal transfusions at 14 and 15 weeks were given followed by two intravascular and seven exchange transfusions. A girl weighing 2,940 g was delivered vaginally at term after external cephalic version for breech presentation. To date her neurological and social development is normal. CONCLUSIONS: Since the success of haematopoietic stem cell transplantations for the treatment of congenital haematologic diseases could imply early and repetitive procedures, this observation enlightens the technical feasibility of such an invasive approach and its relative safety for subsequent development.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
12/53. Fetal hemolytic disease due to anti-Rh17 alloimmunization.OBJECTIVE: To delineate clinical features of a case of fetal hemolytic disease due to anti-Rh17, along with a review of relevant studies published in English and Japanese. methods: We present clinical features of a -D-/-D- phenotype woman with anti-Rh17 alloimmunization during pregnancy. Relevant English literature in the medline database was reviewed, while Japanese studies were searched in the Japana Centra Revuo Medicina database. RESULTS: A Japanese -D-/-D- woman with anti-Rh17 (Hro) was treated during pregnancy. Serial ultrasonography, antibody titers, amniocenteses, and cordocenteses were conducted for perinatal management. amniocentesis results demonstrated a high delta optical density level of 450 in the amniotic fluid, while cordocentesis revealed alloimmunization between the mother and the fetus as well as fetal hemolytic anemia. blood flow velocity in the middle cerebral artery indicated a rapid development of fetal anemia. The newborn demonstrated severe anemia and hyperbilirubinemia, which were successfully treated with exchange transfusions. Two cases of prenatally diagnosed fetal hemolytic disease due to anti-Rh17 were found published in English and 5 in Japanese. CONCLUSION: A -D-/-D- phenotype patient with anti-Rh17 was successfully managed during pregnancy and a good outcome for the neonate was achieved. Our results and a review of related literature led to the following suggestions. The first pregnancy in a -D-/-D- woman may be affected, an anamnestic immune response can easily occur during pregnancy, the level of anti-Rh17 titer is indicative of the degree of fetal hemolysis, and appropriate intrauterine intervention is warranted for achievement of a good outcome.- - - - - - - - - - ranking = 5keywords = pregnancy (Clic here for more details about this article) |
13/53. Maternal ABO-mismatched blood for intrauterine transfusion of severe hemolytic disease of the newborn due to anti-Rh17.BACKGROUND: Clinically significant antibodies to high-incident antigens present a challenge in hemolytic disease of the newborn. Antigen-negative blood may be difficult to obtain for intrauterine transfusion (IUT). In these instances, maternal blood is de facto compatible regardless of an ABO mismatch. CASE REPORT: A group B/D-- woman with a history of hemolytic disease of the newborn due to anti-Rh17 (titer 256) presented to the obstetrical clinic at 12 weeks gestation for management of her third pregnancy. She consented to donate blood for possible IUT. STUDY DESIGN AND methods: Washed maternal packed cells were suspended in saline to 75 percent Hct and irradiated before transfusion. The fetus was transfused via the intrahepatic vein. RESULTS: Ultrasound examination at 19 weeks indicated a hydropic fetus. The fetal blood group was O Rh , direct antiglobulin test 4 , and hemoglobin 22 g per L. A total of 368 mL of maternal blood was transfused during seven procedures. Labor was induced at 38 weeks, and a 2560-g male infant was delivered by Caesarian-section due to fetal distress. The infant grouped as B Rh , direct antiglobulin test negative. No group O red blood cells were detected. The hemoglobin level was 143 g per L rising to 209 g per L at discharge 3 days later. The indirect bilirubin was 55 micromol/L and remained stable during the hospital stay. phototherapy was discontinued after 1 day, and the infant was discharged without an exchange or top-up transfusion. CONCLUSIONS: Maternal ABO-mismatched blood is an alternate source for IUT in instances when antigen-compatible allogenic blood is unavailable.- - - - - - - - - - ranking = 2.1595266980782keywords = gestation, pregnancy (Clic here for more details about this article) |
14/53. The role of preimplantation genetic diagnosis in the management of severe rhesus alloimmunization: first unaffected pregnancy: case report.Rhesus (Rh) D alloimmunization may cause haemolytic disease of the fetus and newborn if the fetal Rh blood type is positive. Although the incidence of severe RhD alloimmunization has decreased with prophylactic anti-D immunoglobulin administration during and after pregnancy, sensitization still occurs in a small group of women. In such women, Rh disease will continue to be significant problem and for their babies who may be affected. Preimplantation genetic diagnosis (PGD) may be utilized to avoid materno-fetal blood group incompatibility in an RhD-sensitized woman. biopsy of a single cell from early cleavage-stage embryos screening for RhD-negative embryos allows the transfer of only RhD-negative embryo(s) into the uterus. This avoids any complications related to haemolytic disease of the fetus and newborn. This article describes the first reported case of an unaffected pregnancy using PGD for Rh disease. IVF and embryo transfer resulted in a clinical pregnancy and the birth of a healthy girl confirmed to be blood type RhD negative. PGD in couples with a heterozygous RhD-positive male partner provides an option for avoiding haemolytic disease of the newborn in RhD alloimmunized mothers.- - - - - - - - - - ranking = 7keywords = pregnancy (Clic here for more details about this article) |
15/53. Intrauterine fetal transfusion.The incidence of perinatal death resulting from rhesus rh isoimmunization has dropped dramatically since the introduction of Rh immunoglobulin. However, Rh sensitization continues to be one of the leading causes of fetal anemia. Our patient is a 38-year-old woman; she gives a history of 2 uneventful pregnancies followed by 5 consecutive stillbirths. Investigations revealed an anti-D titre of 1/2048 and anti-C titre of 1/256. Ultrasound examination revealed fetal ascites at 18 weeks gestation. The fetus had a total of 9 successful intrauterine transfusions. She was delivered by an elective cesarean section at 34 weeks gestation; outcome was a healthy female baby weighing 2060 g. Examination at 9 month of age showed normal growth and neurodevelopment.- - - - - - - - - - ranking = 2.3190533961565keywords = gestation (Clic here for more details about this article) |
16/53. Anti-C(w) alloimmunization presenting as hydrops fetalis.C(w) is a low frequency red cell antigen that belongs to the Rh blood groups system. While not uncommon, anti-C(w) is rarely associated with clinically significant haemolytic disease of the newborn (HDN). When it does occur, it is often subclinical or of mild to moderate clinical severity. In the majority of pregnancies it is considered to be a naturally occurring antibody and has not been reported to cause hydrops fetalis or stillbirth. We report a case of anti-C(w) alloimmunization, which was associated with significant anaemia and hydrops fetalis, presenting at 35 wk gestation. Conclusion: Pregnancies affected by anti-C(w) merit closer scrutiny. Consideration should be given to performing more frequent antenatal ultrasound assessments to detect hydrops fetalis. This may help to support the need for more invasive procedures (cordocentesis and intrauterine transfusions).- - - - - - - - - - ranking = 1.1595266980782keywords = gestation (Clic here for more details about this article) |
17/53. pregnancy affected by isoimmunisation caused by a unique haemolytic rhesus type antibody in a Somali woman.Clinical suspicion and biochemical evidence of isoimmunisation in pregnancy have from contemporary times led to clinical curiousity and intervention at various stages of pregnancy for the sake of the fetus. Some of these interventions only found unnecessary after the causative antibodies have been properly identified and characterised. Hundreds of these antibodies were identified accidentally or by planned clinical and biochemical investigation. Here we present a unique case of isoimmunisation in pregnancy caused by a unique haemolytic antibody.- - - - - - - - - - ranking = 3keywords = pregnancy (Clic here for more details about this article) |
18/53. Severe hemolytic disease of the newborn due to anti-Cw.BACKGROUND: Pregnancies complicated by rh isoimmunization have decreased significantly since the widespread use of Rh immune globulin. Uncommon red blood cell antigens have therefore become more clinically evident. We report a case of anti-Cw immunization that resulted in severe fetal anemia that required multiple transfusions. CASE: A 28-year-old multigravida presented to our service at 18 weeks of gestation with her fourth pregnancy. Her pregnancy was complicated by anti-Cw isoimmunization that resulted in severe fetal anemia requiring in utero fetal blood transfusions. CONCLUSION: While previous reports recommend only postpartum surveillance when Cw isoimmunization is present, we report a case resulting in severe fetal anemia.- - - - - - - - - - ranking = 3.1595266980782keywords = gestation, pregnancy (Clic here for more details about this article) |
19/53. The issue of anti-D: an integrated seamless approach from recognition of need to bedside administration.BACKGROUND: The appropriate and timely administration of Anti-D immunoglobulin to Rhesus (D) negative women who have delivered Rhesus (D) positive babies is a vital part of obstetric care. Anti-D has an especially high profile in ireland because of the tragic inadvertent transmission of hepatitis c to Irish women in past decades. AUDIT: We have reviewed our policy and procedures pertaining to the administration of Anti-D for sensitising events during pregnancy and postnatally, in the Mid-Western health Board in 1999/2000. As a result, major changes were made in the storage, issue, recording and administration of Anti-D. New procedures in the transfusion laboratory and in the maternity hospital have been accepted by scientists and midwives and supported by haematology and obstetric medical staff. The pharmacy and haematology laboratory no longer have a role in this programme. IMPLEMENTATION OF MULTI-DISCIPLINARY CHANGE MANAGEMENT: As a result of these changes, the storage, issuing and tracking of Anti-D has become the responsibility of the hospital blood bank. Measurement offoeto-maternal haemorrhage (FMH) is now the responsibility of bio medical scientists in blood bank, utilising both flow cytometry (increasingly recognised as the gold standard method) and the Kleihauer method (Kleihauer-Betke).The programme has moved from a doctor-administered IV Anti-D Ig, to a midwife-administered IM preparation. Prescription remains the responsibility of the doctor.These changes are facilitated by the protocol guided issue of the appropriate dose of Anti-D Ig by bio medical scientists to midwives. The issue of the Anti-D Ig occurs simultaneously with issue of results of mother and baby's serology testing and estimation of volume of FMH.These major changes have been guided by audit and needs assessment and require close liaison between medical, nursing and laboratory scientific staff in haematology, transfusion and obstetrics. CRITICAL INCIDENT AUDIT-CASE REPORT: Before new procedures became official policy, a critical incident audit allowed us to pilot our protocol and to revise it using draft new procedures. In this critical incident we describe successful management of a patient with a large foeto-maternal haemorrhage. This incident supported the need for the procedural enhancements already underway. This critical incident re-emphasised the need for the planned systems improvements to be introduced quickly.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
20/53. Serologic and molecular genetic management of a pregnancy complicated by anti-Rh18.antibodies, such as anti-Rh18 (Hr/Hr(S)), that react with the common products of RHCE can cause HDN as well as severe hemolytic transfusion reactions. Individuals with anti-Rh18 antibodies can have different RHCE genetic backgrounds; therefore, sera and RBCs from these individuals may cross-react. In these situations, genotyping may be the best method to determine compatibility. We report a 26-year-old pregnant Puerto Rican woman who presented at 31 weeks' gestation with anti-E and anti-Rh18 in her serum. No potential donors were identified among family members or within the American Rare Donor Program; therefore, a unit of the patient's RBCs was collected one week before her planned caesarian section. To improve our ability to supply blood for this patient in the future, molecular testing was performed. The patient was found to be homozygous for an RH haplotype in which a variant RHD*DAR, is linked to a variant RHCE*ceAR. The DAR-ceAR haplotype has been described in Dutch-African populations, but this is the first report of an individual self-identified of Hispanic ethnicity. This case report demonstrates the clinical importance of molecular testing of patients with rare Rh phenotypes.- - - - - - - - - - ranking = 5.1595266980782keywords = gestation, pregnancy (Clic here for more details about this article) |
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