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Jackson ME, Grabowska K, Lieberman L, Clarke G, Yan MTS. Letter to the Editor: Management of Pregnancies Alloimmunized with Non-Rh and Non-K Alloantibodies. J Obstet Gynaecol Can 2024; 46:102299. [PMID: 38548447 DOI: 10.1016/j.jogc.2023.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 04/02/2024]
Affiliation(s)
- Melanie E Jackson
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON
| | - Kirsten Grabowska
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Fraser Health Authority, Surrey and New Westminster, BC
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON
| | - Gwen Clarke
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON
| | - Matthew T S Yan
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC.
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Jackson ME, Grabowska K, Lieberman L, Clarke G, Yan MTS. Management of Pregnancies Alloimmunized with Non-Rh and Non-K Alloantibodies. Journal of Obstetrics and Gynaecology Canada 2024; 46:102189. [PMID: 37558164 DOI: 10.1016/j.jogc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Melanie E Jackson
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON
| | - Kirsten Grabowska
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Fraser Health Authority, Surrey and New Westminster, BC
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, ON
| | - Gwen Clarke
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON
| | - Matthew T S Yan
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, ON; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC.
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Zwiers C, van der Bom JG, van Kamp IL, van Geloven N, Lopriore E, Smoleniec J, Devlieger R, Sim PE, Ledingham MA, Tiblad E, Moise KJ, Gloning KP, Kilby MD, Overton TG, Jørgensen DS, Schou KV, Paek B, Walker M, Parry E, Oepkes D, de Haas M. Postponing Early intrauterine Transfusion with Intravenous immunoglobulin Treatment; the PETIT study on severe hemolytic disease of the fetus and newborn. Am J Obstet Gynecol 2018; 219:291.e1-291.e9. [PMID: 29902448 DOI: 10.1016/j.ajog.2018.06.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/18/2018] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intrauterine transfusion for severe alloimmunization in pregnancy performed <20 weeks' gestation is associated with a higher fetal death rate. Intravenous immunoglobulins may prevent hemolysis and could therefore be a noninvasive alternative for early transfusions. OBJECTIVE We evaluated whether maternal treatment with intravenous immunoglobulins defers the development of severe fetal anemia and its consequences in a retrospective cohort to which 12 fetal therapy centers contributed. STUDY DESIGN We included consecutive pregnancies of alloimmunized women with a history of severe hemolytic disease and by propensity analysis compared index pregnancies treated with intravenous immunoglobulins (n = 24) with pregnancies managed without intravenous immunoglobulins (n = 28). RESULTS In index pregnancies with intravenous immunoglobulin treatment, fetal anemia developed on average 15 days later compared to previous pregnancies (8% less often <20 weeks' gestation). In pregnancies without intravenous immunoglobulin treatment anemia developed 9 days earlier compared to previous pregnancies (10% more <20 weeks), an adjusted 4-day between-group difference in favor of the immunoglobulin group (95% confidence interval, -10 to +18; P = .564). In the subcohort in which immunoglobulin treatment was started <13 weeks, anemia developed 25 days later and 31% less <20 weeks' gestation (54% compared to 23%) than in the previous pregnancy. Fetal hydrops occurred in 4% of immunoglobulin-treated pregnancies and in 24% of those without intravenous immunoglobulin treatment (odds ratio, 0.03; 95% confidence interval, 0-0.5; P = .011). Exchange transfusions were given to 9% of neonates born from pregnancies with and in 37% without immunoglobulin treatment (odds ratio, 0.1; 95% confidence interval, 0-0.5; P = .009). CONCLUSION Intravenous immunoglobulin treatment in mothers pregnant with a fetus at risk for hemolytic disease seems to have a potential clinically relevant, beneficial effect on the course and severity of the disease. Confirmation in a multicenter randomized trial is needed.
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Affiliation(s)
- Carolien Zwiers
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge L van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - John Smoleniec
- Feto-Maternal Unit, Liverpool Hospital, Liverpool, Australia
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Pauline E Sim
- Ian Donald Fetal Medicine Unit, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - Marie Anne Ledingham
- Ian Donald Fetal Medicine Unit, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kenneth J Moise
- McGovern Medical School, UT Health; Fetal Center, Children's Memorial Hermann Hospital, Houston, TX
| | | | - Mark D Kilby
- Fetal Medicine Center, Birmingham Women's and Children's Foundation Trust, and Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | | | - Ditte S Jørgensen
- Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Katrine V Schou
- Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Bettina Paek
- Evergreen Fetal Therapy Program, Evergreen Health Medical Center, Kirkland, WA
| | - Martin Walker
- Evergreen Fetal Therapy Program, Evergreen Health Medical Center, Kirkland, WA
| | - Emma Parry
- Maternal-Fetal Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja de Haas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands; Immunohematology Diagnostic Services, Sanquin Blood Supply, Amsterdam, The Netherlands
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Roybal JL, Moldenhauer JS, Khalek N, Bebbington MW, Johnson MP, Hedrick HL, Adzick NS, Flake AW. Early delivery as an alternative management strategy for selected high-risk fetal sacrococcygeal teratomas. J Pediatr Surg 2011; 46:1325-32. [PMID: 21763829 DOI: 10.1016/j.jpedsurg.2010.10.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 10/21/2010] [Accepted: 10/25/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Large, prenatally diagnosed sacrococcygeal teratomas (SCTs) present a formidable challenge because of their unpredictable growth and propensity for complications. In our experience, even with aggressive serial imaging, many fetuses have died under a policy of "watchful waiting." We propose "early delivery" as the best option for selected cases of high-risk fetal SCT. METHODS The medical charts of all fetuses with SCT followed up at our institution and delivered before 32 weeks of gestation were reviewed for radiologic findings, fetal interventions, delivery information, perinatal inpatient course, and autopsy or discharge report. RESULTS Between 1996 and 2009, excluding those that underwent fetal surgery, 9 patients with fetal SCT were delivered before 32 weeks of gestation. Four had type I tumors, and 5 had type II tumors. Of the 9 fetuses, 4 survived the neonatal period. The only surviving patient delivered before 28 weeks underwent an ex utero intrapartum therapy procedure. CONCLUSIONS A significant number of pregnancies complicated by high-risk SCT will manifest signs of fetal or maternal decompensation, or both, between 27 and 32 weeks of gestation. In the absence of fulminant hydrops, preemptive early delivery can be associated with surprisingly good outcomes in appropriately selected fetuses with high-risk SCT.
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Affiliation(s)
- Jessica L Roybal
- The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, PA, USA
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Abstract
Pregnant women who report possible exposure to a viral illness can present a clinical predicament for obstetric providers. Although some viruses are benign in pregnancy, others can have serious consequences. Parvovirus B19, the causative agent of fifth disease, is one of the more serious of the common viruses. Understanding the pathophysiology and appropriate testing for parvovirus will help providers better counsel their patients.
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Affiliation(s)
- Meredith Goff
- Midwifery Education Program, Yale University School of Nursing, USA.
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Yap C, Wang W, Tan ASC, Tan WC, Lim MN, Chong SS. Successful preimplantation genetic diagnosis of Hb Bart's hydrops fetalis in Singapore after fresh and frozen embryo replacement cycles. Ann Acad Med Singap 2009; 38:910-913. [PMID: 19890585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION We report the fi rst successful preimplantation genetic diagnosis (PGD) for Hb Bart's hydrops fetalis in Singapore, involving both fresh and frozen embryo replacement cycles. CLINICAL PICTURE Two couples who were carriers of the Southeast Asian type double gene deletion (--(SEA) deletion carriers) requested for PGD. Couple A had 2 previous affected pregnancies, while couple B have a child of unknown genotypic status. TREATMENT One PGD cycle was performed for each couple. The --(SEA) deletion was detected using a gap-PCR strategy. Couple A had 1 fresh-embryo replacement cycle while couple B underwent 2 frozen-embryo replacement cycles. OUTCOME Couple A achieved a twin pregnancy. Second trimester complications resulted in premature delivery, where 1 baby girl survived. Couple B achieved a singleton pregnancy resulting in delivery of a healthy baby boy. Genotype analysis of all babies confirmed the PGD results consistent with clinically unaffected status. CONCLUSIONS We have successfully performed PGD to avoid Hb Bart's hydrops fetalis syndrome.
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Affiliation(s)
- Christine Yap
- Women's Health and Fertility Centre, Mount Elizabeth Medical Centre, Singapore
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Finamore PS, Kontopoulos E, Price M, Giannina G, Smulian JC. Mirror syndrome associated with sacrococcygeal teratoma: a case report. J Reprod Med 2007; 52:225-7. [PMID: 17465292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Mirror syndrome is associated with both nonimmune and immune hydrops fetalis. The clinical manifestations are quite varied, and the pathophysiology is poorly understood. We describe a case of mirror syndrome associated with afetus that had a rapidly growing sacrococcygeal teratoma (SCT) without overt hydrops. CASE At 30 weeks' gestational age a fetus with SCT began to show early sonographic evidence of right heart failure, placentomegaly and polyhydramnios without overt fetal hydrops. Shortly after these findings were noted, the mother began to develop hypertension, epigastric pain, proteinuria and thrombocytopenia. These findings were all reversed after delivery of the fetus. Subsequent surgery on the infant was successful. CONCLUSION Mirror syndrome has been linked with SCT and is usually associated with severe fetal hydropic changes. In our case the development of mirror syndrome preceded the manifestations of overt hydrops. Identification of early signs of fetal compromise or hydrops may help to predict patients who will develop mirror syndrome and improve outcomes with earlier intervention.
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Affiliation(s)
- Peter S Finamore
- Division of Maternal Fetal Medicine, University of Medicine and Dentistry/Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
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Akcakus M, Koklu E, Bilgin M, Kurtoglu S, Altunay L, Canpolat M, Budak N. Congenital pulmonary lymphangiectasia in a newborn: a response to autologous blood therapy. Neonatology 2007; 91:256-9. [PMID: 17568156 DOI: 10.1159/000098172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/05/2006] [Indexed: 12/16/2022]
Abstract
Congenital pulmonary lymphangiectasia is a rare condition that may present antenatally with pleural effusions and hydrops, and the prognosis is reported to be very poor. Treatments for lymphangiectasia have included corticosteroids for patients with primary inflammatory conditions, dietary modifications, surgical resection for isolated lesions, octreotide, antiplasmin therapy and fibrin glue pleurodesis. However, there is no experience with pleurodesis by autologous blood therapy in the literature. We present a newborn with primary pulmonary lymphangiectasis who developed progressively profuse chylous pleural effusions after enteral full feeding from the 8th day of life and improved with pleurodesis by autologous blood therapy.
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Affiliation(s)
- Mustafa Akcakus
- Division of Neonatology, Department of Paediatrics, School of Medicine, Erciyes University, Kayseri, Turkey
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Li D, Liao C, Li J, Xie X, Huang Y, Zhong H. Detection of alpha-thalassemia in beta-thalassemia carriers and prevention of Hb Bart's hydrops fetalis through prenatal screening. Haematologica 2006; 91:649-51. [PMID: 16627247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 03/06/2006] [Indexed: 05/08/2023] Open
Abstract
The aim of this study was to detect alpha-thalassemia in beta-thalassemia carriers during prenatal screening. During a 12-year prenatal screening program, a total of 158 couples (3.2%) were diagnosed to be the discordant alpha- and beta-thalassemia carriers. Of the 158 beta-thalassemia partners, seven (4.4%) were found to have co-inheritance of alpha0-thalassemia, and three (1.9%) found to have co-inheritance of alpha(+)-thalassemia. Three pregnancies affected with Hb Bart's hydrops fetalis were terminated in the 158 couples. The results showed that molecular analysis must be used for accurate diagnosis of double heterozygotes in couples presumed to be discordant for alpha- and beta-thalassemia on hematologic testing.
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Affiliation(s)
- Dongzhi Li
- Prenatal Diagnostic Center, Guangzhou Maternal & Neonatal Hospital, Guangzhou Medical College, Guangzhou, Guangdong, China.
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Dimas VV, Dimasc VV, Taylor MD, Cunnyngham CB, Overholt ED, Bourne DWA, Stanely JR, Sheikh A, Wolf R, Valentine B, Ward KE. Transplacental pharmacokinetics of flecainide in the gravid baboon and fetus. Pediatr Cardiol 2005; 26:815-20. [PMID: 16132275 DOI: 10.1007/s00246-005-0974-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to characterize the transfer of flecainide across the placenta and determine the fetal: maternal ratio of flecainide in the gravid baboon. Flecainide acetate has been especially successful for the treatment of fetal supraventricular tachycardia associated with hydrops fetalis. However, the degree of transplacental transmission remains unknown. In this study, all animals were placed under general anesthesia. Flecainide 2.5 mg/kg was administered intravenously. Percutaneous umbilical blood sampling was performed simultaneously with maternal sampling. Flecainide levels were measured using high-performance liquid chromatography with ultraviolet detection. A total of six gravid baboons were studied at an average gestational age of 132 days. The mean maternal volume of distribution at steady state was 5.1 +/- 1.8 L/kg. The mean combined elimination constant (k(el)) was 0.79 +/- 0.19 hr(-1) [95% confidence interval (CI), 0.64-0.93]. There was a linear relationship between maternal and fetal concentrations, with a ratio of fetal-to-maternal serum levels of 0.49 +/- 0.05 (95% CI, 0.39-0.59). At steady state, fetal flecainide levels are approximately 50% of maternal flecainide levels. Flecainide is rapidly distributed in the mother and fetus following a single intravenous dose with a maternal volume of distribution similar to that reported in normal healthy human adults. Since fetal levels correlate closely with maternal levels, we propose that it is possible to estimate fetal levels by monitoring maternal levels.
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Affiliation(s)
- V V Dimas
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, MC 19345-C, Houston, TX 77030, USA.
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Abstract
OBJECTIVE To review cases of anti-c isoimmunization and determine the most appropriate management strategies. METHODS We performed a review of 102 pregnancies managed at The Ohio State University from 1967 to 2001 for anti-c isoimmunization. Of these, 55 had complete data and are included in this report. Information collected included serum titers, deltaOD450 values, Liley zones, fetal and neonatal hemoglobin levels and antigen typing, neonatal direct antiglobulin test, and neonatal outcomes. The appropriateness of traditional management was then evaluated. RESULTS Of the 55 pregnancies, 46 had fetuses with positive direct antiglobulin test, and nine pregnancies had unaffected fetuses. Of the affected neonates, 12 (26%) had serious hemolytic disease of the newborn. Of these 12, 8 required fetal transfusion, and the remaining 4 newborns had hemoglobin levels of less than 10 g/dL at the time of delivery. A titer of 1:32 or greater or the presence of hydrops fetalis identified all such fetuses. There were 58 amniocenteses performed for deltaOD450 When plotted on modified Liley graphs, deltaOD450 values corresponded to disease severity. There were no perinatal deaths attributable to anti-c hemolytic disease of the newborn. CONCLUSION Anti-c isoimmunization might cause significant fetal and newborn hemolytic disease. A titer of 1:32 or greater or evidence of hydrops fetalis identified all the serious hemolytic disease at our institution. The significance of antibody titers and deltaOD450 values was similar to Rh-D sensitized pregnancies, and management by the same modalities is appropriate.
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Affiliation(s)
- David N Hackney
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine and Public Health, Columbus, Ohio, USA
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Brandenburg H, de Krijger RR, Visser W, Wessels MW, Steegers EAP. [Maternal complications of fetal hydrops]. Ned Tijdschr Geneeskd 2002; 146:2367-70. [PMID: 12510402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Three women, aged 28, 27 and 25 years, two primigravidae and one woman who had given birth to a hydropic child previously, had four pregnancies with hydrops of the foetus and the placenta: two (in the same patient) due to foetal cardiomyopathy and two with foetal heart block. The patients developed severe oedema and preeclampsia. After the delivery they recovered well. Since the introduction of anti-D rhesus immunoprophylaxis, foetal hydrops has become less frequent. The resulting maternal complications (the maternal hydrops syndrome and enlarged polycystic ovaries) are therefore less well-known. Serious maternal complications occur in around 50% of cases of foetal hydrops. Careful monitoring of the maternal condition in cases of foetal hydrops is therefore warranted.
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Affiliation(s)
- H Brandenburg
- Afd. Verloskunde en Vrouwenziekten, Erasmus Medisch Centrum, locatie Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam.
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Crane J. Parvovirus B19 infection in pregnancy. J Obstet Gynaecol Can 2002; 24:727-43; quiz 744-6. [PMID: 12360369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVES (1) To review the effects of parvovirus B19 on the pregnant woman and fetus, and (2) to discuss the management of women who are exposed to, who are at risk of developing, or who develop parvovirus B19 infection in pregnancy. OUTCOMES Maternal outcomes of parvovirus B19 including erythema infectiosum, arthropathy, anemia, and myocarditis. Fetal outcomes including spontaneous abortion, congenital anomalies, hydrops fetalis, stillbirth, and long-term effects. EVIDENCE MEDLINE search from 1966 to January 2002 for articles relating to parvovirus B19 infection, using key words "parvovirus" and "pregnancy," and guidelines of professional organizations including the American College of Obstetricians and Gynecologists. VALUES The evidence obtained was reviewed and evaluated by both the Maternal Fetal Medicine and Infectious Diseases Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and recommendations were made according to guidelines developed by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS 1. Pregnant women exposed to, or who develop symptoms of, parvovirus B19 infection should be assessed to determine if they are susceptible to infection (nonimmune) or if they have a current infection, by determining their parvovirus B19 IgG and IgM status. (II-2A) 2. If parvovirus B19 IgG is present and IgM is negative, the woman is immune and can be reassured that she will not develop infection and that the virus will not adversely affect her pregnancy. (II-2A) 3. If both parvovirus B19 IgG and IgM are negative (and the incubation period has passed), the woman is not immune and has not developed the infection. Although she may wish to minimize further exposure, leave from the workplace is controversial and is not routinely recommended. Further studies are needed in this area. (III-B) 4. If a recent parvovirus B19 infection has been diagnosed in the woman, then referral to an obstetrician or a maternal-fetal medicine specialist should be considered (III-B). The woman should be counselled regarding risks of fetal transmission, fetal loss, and hydrops. Serial ultrasounds should be performed up to 8 to 12 weeks after infection to detect the development of hydrops (III-B). If hydrops develops, referral to a maternal-fetal medicine specialist should be made and consideration should be given to fetal blood sampling and intravascular transfusion (II-2B). VALIDATION These guidelines have been reviewed and approved by the Maternal Fetal Medicine and Infectious Diseases Committees of the SOGC, and the Council of the SOGC.
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Lorey F, Cunningham G, Vichinsky EP, Lubin BH, Witkowska HE, Matsunaga A, Azimi M, Sherwin J, Eastman J, Farina F, Waye JS, Chui DH. Universal newborn screening for Hb H disease in California. Genet Test 2002; 5:93-100. [PMID: 11551109 DOI: 10.1089/109065701753145538] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Newborn screening is an accepted public health measure to ensure that appropriate health care is provided in a timely manner to infants with hereditary/metabolic disorders. Alpha-thalassemia is a common hemoglobin (Hb) disorder, and causes Hb H (beta4) disease, and usually fatal homozygous alpha(0)-thalassemia, also known as Hb Bart's (gamma4) hydrops fetalis syndrome. In 1996, the State of California began to investigate the feasibility of universal newborn screening for Hb H disease. Initial screening was done on blood samples obtained by heel pricks from newborns, and stored as dried blood spots on filter paper. Hb Bart's levels were measured as fast-moving Hb by automated high-performance liquid chromatography (HPLC) identical to that currently used in newborn screening for sickle cell disease. Subsequent confirmation of Hb H disease was done by DNA-based diagnostics for alpha-globin genotyping. A criterion of 25% or more Hb Bart's as determined by HPLC detects most, if not all cases of Hb H disease, and few cases of alpha-thalassemia trait. From January, 1998, through June, 2000, 89 newborns were found to have Hb H disease. The overall prevalence for Hb H disease among all newborns in California is approximately 1 per 15,000. Implementation of this program to existing newborn hemoglobinopathy screening in populations with significant proportions of southeast Asians is recommended. The correct diagnosis would allow affected infants to be properly cared for, and would also raise awareness for the prevention of homozygous alpha(0)-thalassemia or Hb Bart's hydrops fetalis syndrome.
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Affiliation(s)
- F Lorey
- Genetic Disease Branch, California Department of Health Services, Berkeley 94704, USA.
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Tongsong T, Wanapirak C, Sirivatanapa P, Sa-nguansermsri T, Sirichotiyakul S, Piyamongkol W, Chanprapaph P, Steger HF, Sekararithi R, Tuggapichitti A. Prenatal eradication of Hb Bart's hydrops fetalis. J Reprod Med 2001; 46:18-22. [PMID: 11209626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of prenatal prevention of Hb Bart's hydrops fetalis. STUDY DESIGN The study was a prospective descriptive analysis of pregnant women attending an antenatal clinic between June 1990 and June 1998. The study consisted of two periods, the first half with no prenatal diagnosis (PND) (1990-1994) and the second half with PND. During the study period, all cases of Hb Bart's hydrops fetalis were prospectively collected and postnatally confirmed. In the second period, prenatal strategy to control severe thalassemia was introduced. The strategy included (1) carrier identification by retrospective (history review for known risk) and prospective screening (simple erythrocyte osmotic fragility test) in women without known risks, (2) the couples at risk were offered genetic counseling and cordocentesis, (3) analysis of fetal blood for diagnosis, and (4) counseling for termination of pregnancy. RESULTS During the first half of the study, the prevalence of Hb Bart's hydrops fetalis was 0.305 (89 in 29,399 deliveries). There were no fetuses with Hb Bart's hydrops fetalis among 16,360 screened pregnancies in the second half. However, of 6,856 pregnancies in the second half not screened due to a late first visit, 10 (0.15%) fetuses had Hb Bart's hydrops fetalis. Among the screened group, cordocentesis was performed in 361 pregnancies at risk, 170 and 191 from retrospective and prospective screening, respectively; and 75 (20.8%) were proven to have Hb Bart's disease, which was diagnosed before hydropic changes occurred. CONCLUSION The strategy proved effective in preventing Hb Bart's hydrops fetalis, and extensive experience with it suggests that it be considered an effective way to control severe thalassemia.
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Affiliation(s)
- T Tongsong
- Departments of Obstetrics and Gynecology and of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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Abstract
In the majority of cases, the diagnosis of an isolated fetal tachyarrhythmia results in a favorable perinatal outcome. Although there is general consensus on the management of fetal extrasystoles, refractory supraventricular tachycardia, and atrial flutter and fibrillation, the optimal approach to supraventricular tachycardia without hemodynamic compromise remains uncertain. The benefits of conservative management without antiarrhythmic therapy must be weighed carefully against the lack of reliable predictors for the development of fetal hydrops and associated neurologic complications.
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Affiliation(s)
- L L Simpson
- Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Columbia University Faculty of Medicine, NY 10032, USA.
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Kwan Ma ES, Yin Chan AY, Yin Ha S, Fung Chan GC, Lung Lau Y, Chan LC. Screening for (--SEA) alpha-globin gene deletion in beta-thalassemia carriers and prevention of hydrops fetalis. Haematologica 2000; 85:991-3. [PMID: 10980643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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18
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van Kamp IL, Klumper FJ, Meerman RH, Brand A, Bennebroek Gravenhorst J, Kanhai HH. [Blood group immunization: results of treatment of fetal anemia with intra-uterine intravascular blood transfusion in the Netherlands, 1987-1995]. Ned Tijdschr Geneeskd 1999; 143:2527-31. [PMID: 10627756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To evaluate outcome of red cell alloimmunized pregnancies treated with intravascular intrauterine blood transfusions. DESIGN Retrospective. METHODS Medical records of all women and neonates treated with intrauterine transfusions in the period March 1987-December 1995, were reviewed. Survival rates of the infants were analysed in relation to both gestational age and the presence or absence of hydrops at the time of the first transfusion. RESULTS In 153 pregnancies 155 foetuses underwent 462 transfusions (median: 3; range: 1-7). Patients were immunized against RhD in 88%. Kell in 7% and Rhe in 5% of the cases. Overall survival rate was 83%. No difference in survival rate was found between children with the first transfusion early (< or = 26 weeks) or late (> 26 weeks) in pregnancy. Survival rate for foetuses without hydrops was significantly higher than for those with hydrops (90% versus 73%). The mildly hydropic foetuses had a significantly higher survival rate than the severely hydropic foetuses (94% versus 53%). Absence of intrauterine reversal of hydrops was associated with a bad outcome. CONCLUSION Intravascular transfusion is an effective and safe procedure for correction of foetal anaemia provided it is performed by an experienced multidisciplinary team. In contrast to gestational age at first transfusion severity of hydrops is predictive for successful treatment, so timely institution of treatment is of paramount importance.
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MESH Headings
- Blood Group Antigens/immunology
- Blood Group Incompatibility/epidemiology
- Blood Group Incompatibility/immunology
- Blood Transfusion, Intrauterine/mortality
- Blood Transfusion, Intrauterine/statistics & numerical data
- Erythroblastosis, Fetal/immunology
- Erythroblastosis, Fetal/mortality
- Erythroblastosis, Fetal/therapy
- Female
- Gestational Age
- Humans
- Hydrops Fetalis/complications
- Hydrops Fetalis/prevention & control
- Infant, Newborn
- Isoantibodies/blood
- Netherlands/epidemiology
- Population Surveillance
- Pregnancy
- Pregnancy Complications, Hematologic/blood
- Pregnancy Complications, Hematologic/epidemiology
- Pregnancy Complications, Hematologic/immunology
- Pregnancy Complications, Hematologic/therapy
- Retrospective Studies
- Severity of Illness Index
- Survival Rate
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Affiliation(s)
- I L van Kamp
- Afd. Verloskunde, Leids Universitair Medisch Centrum, Leiden
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19
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Stone DL, Sidransky E. Hydrops fetalis: lysosomal storage disorders in extremis. Adv Pediatr 1999; 46:409-40. [PMID: 10645471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In recent years there has been an increased recognition that hydrops fetalis may be an extreme presentation of many of the lysosomal storage disorders. Hydrops fetalis, the excessive accumulation of serous fluid in the subcutaneous tissues and serous cavities of the fetus, has many possible etiologies, providing a diagnostic challenge for the physician. Ten different lysosomal storage disorders have now been diagnosed in infants with hydrops fetalis, including mucopolysaccharidosis (MPS) VII and IVA, type 2 Gaucher disease, sialidosis, GMI gangliosidosis, galactosialidosis, Niemann-Pick disease type C, disseminated lipogranulomatosis (Farber disease), infantile free sialic acid storage disease (ISSD), and mucolipidosis II (I-cell disease). Frequently, these inborn errors of metabolism are recognized only after the unfortunate recurrence of hydrops fetalis in several pregnancies of a family. Making the diagnosis relies on the physician having a high index of suspicion and ordering appropriate testing, which can often be performed prenatally. In several of these disorders, including MPS VII, infantile galactosialidosis, type 2 Gaucher disease, and ISSD, hydrops fetalis is a relatively common presentation. A greater physician awareness of hydrops fetalis as a presentation of lysosomal disease will facilitate establishing a diagnosis in cases that would have previously been considered idiopathic and will enable a better estimation of the incidence of this association. Lysosomal disorders are among the few causes of nonimmune hydrops fetalis in which an accurate recurrence risk can be ascertained. With an early and accurate diagnosis, genetic counseling and family planning can be offered in these difficult cases.
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Affiliation(s)
- D L Stone
- Clinical Neuroscience Branch, National Institute of Mental Health, Bethesda, Maryland, USA
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20
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Kor-anantakul O, Suwanrath CT, Leetanaporn R, Suntharasaj T, Liabsuetrakul T, Rattanaprueksachart R. Prenatal diagnosis of thalassemia in Songklanagarind Hospital in southern Thailand. Southeast Asian J Trop Med Public Health 1998; 29:795-800. [PMID: 10772567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
A thalassemia screening program for pregnant women has been established in Songklanagarind Hospital since 1992. After genetic counseling, a total of 5078 pregnant women accepted entry into a screening program for thalassemia. Couples at risk who should receive prenatal diagnosis were 2.8%. Total cases who accepted prenatal diagnosis were 135. Total clinical cases were 40 (29.6%) with achievement by prenatal diagnosis of 33 cases (82.5%). Genetic amniocentesis is the most acceptable method for prenatal diagnosis. Five cases (12.5%) were misdiagnosed due to contamination of maternal blood cells in amniotic fluid cases. Questionable results were reported in 2 cases (5%). Abortion occurred in one case (0.7%). Improvement of surgical technic in prenatal diagnosis reduced the complications and contamination of maternal cells. This program shows the feasibility of prevention and control of thalassemia disease in southern Thailand.
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Affiliation(s)
- O Kor-anantakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songklanagarind Hospital, Hat Yai, Songkhla, Thailand
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21
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Abstract
Congenital complete atrioventricular block is a rare entity. The association between this disease, maternal connective tissue disease and maternal antibodies [anti-Ro (SS-A) resp. anti-La (SS B)] is well known. Diagnosis can be made by means of fetal Doppler-echocardiography by the 16th week of gestation. In our case diagnosis was established in the 21st week of gestation. Ventricular rate was 55/min, atrial rate 70/min. There were no signs of fetal hydrops. There were no signs of maternal connective tissue disease, but anti-Ro and anti-La antibodies could be detected. The mother was treated with steroids from the time of diagnosis until the end of pregnancy. Altogether 9 Doppler-echocardiographic studies were performed. A recurrence of normal rhythm did not occur. A slow but continuous decrease of atrial and ventricular rate was observed. Interestingly, there was no development of fetal hydrops until the very end of pregnancy when the fetal heart rate reached a low of 28 beats per minute. We speculate, that the therapy with steroids might have played an important role in the prevention of early hydrops. At the onset of fetal hydrops delivery should be considered. In symptomatic complete atrioventricular block we prefer the implantation of a permanent pacemaker system immediately after birth. Efficient care for the fetus resp. the newborn can only be achieved through well planned cooperation.
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Affiliation(s)
- G Hofstadler
- Department für pädiatrische Kardiologie, Landeskinderklinik Linz
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22
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Abstract
We reviewed the ultrasonographic studies and the clinical course of 22 fetuses with supraventricular tachycardia to determine whether the heart rate alone could serve as a basis for conservative management. Hydrops was not encountered with heart rates under 230 beats per minute. The conditions of all 22 fetuses stabilized without invasive administration of medications. Eighteen were delivered vaginally and only four by cesarean section. No fetal or neonatal losses occurred. Regardless of the type of supraventricular tachycardia, reducing heart rate in these fetuses to levels preventing or resolving hydrops allowed term vaginal delivery, thereby reducing the substantial problems of ventilating an immature or hydropic neonate.
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Affiliation(s)
- W G Guntheroth
- Department of Pediatrics (Cardiology), University of Washington School of Medicine, Seattle 98195-6320, USA
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23
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Abstract
The management of (Rhesus) hemolytic disease of the fetus and newborn includes intrauterine transfusions to prevent the development of hydrops, treatment of the possible hyperbilirubinemia in the immediate postnatal period, and treatment of late anemia. Low levels of serum erythropoietin due to suppression of the bone marrow by multiple intrauterine transfusions is a suggested mechanism for this anemia. The aim of our study was to test whether recombinant human erythropoietin reduced the need for erythrocyte transfusions in these infants. Twenty infants with Rhesus isoimmunization were blindly randomized to treatment and control groups at the 2nd wk of life. The number of intrauterine and exchange transfusions and demographic data were similar in both groups. The infants in the treatment group received recombinant human erythropoietin, s.c. 200 U/kg of body weight three times a week for a period of 6 wk, whereas the infants in the control group received a placebo for the same period. In the treatment group, the mean number of erythrocyte transfusions was significantly lower than that of the control group (1.8 versus 4.2). The reticulocyte counts and Hb levels rose earlier in the treatment group. The platelet and neutrophil counts were similar in both groups throughout the study. This study demonstrates that recombinant human erythropoietin treatment decreases the need for erythrocyte transfusions in the late anemia of infants with Rh isoimmunization. Considering the risks of blood transfusions, this decrease in the donor exposure is worthwhile.
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Affiliation(s)
- F Ovali
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Medical Faculty, Turkey
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24
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Haverkamp F, Jacobs D, Cantz M, Hansmann M, Fahnenstich H, Zerres K. Nonimmune hydrops fetalis with galactosialidosis: consequences for family planning. Fetal Diagn Ther 1996; 11:114-9. [PMID: 8838767 DOI: 10.1159/000264289] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
At the 28th week of gestation a hydrops fetalis was first detected by ultrasound. At birth a generalized hydrops with Hurler-like craniofacial dysmorphism, hepatosplenomegaly and a moderate dystostosis multiplex was noted. High urinary excretion of oligosaccharides and a severe deficiency of neuraminidase and of beta-galactosidase in cultured skin fibroblasts could be found. Thus, a rare early infantile type of galactosialidosis was diagnosed. The patient died at the age of 3 months because of cardiac failure. The consanguineous but otherwise healthy parents received genetic counselling for further pregnancies and have been informed about the possibility of prenatal diagnosis. In view of this possibility, the parents decided to have more children. In the second pregnancy a severe combined enzyme deficiency had been detected and the pregnancy interrupted. In the third pregnancy prenatal diagnosis revealed normal fetal enzyme activities. It resulted in a healthy female child and in the fourth pregnancy reduced but still in the heterozygote level enzyme activities had been found, a healthy boy was born.
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Affiliation(s)
- F Haverkamp
- Zentrum für Kinderheilkunde, Universität Bonn, Deutschland
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25
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Abstract
Hydrops fetalis, a condition characterized by abnormal accumulation of fluid and edema in the fetus, is the final common pathway in a number of pathological conditions. The diagnosis of hydrops is based on ultrasonographic findings of generalized edema along with a serous effusion (ascites, pleural effusion, or pericardial effusion). Polyhydramnios and placentomegaly may also be present. Historically, hydrops fetalis has been described in cases of Rh alloimmunization and severe erythroblastosis (immune hydrops). Hydrops is considered "nonimmune" if there is no evidence of fetal-maternal blood group incompatibility. Over the past few decades, nonimmune hydrops has been recognized more frequently. In a number of series, 80% to 90% of hydropic fetuses were considered nonimmune. Incidence ranges from 1 in 1,500 to 1 in 3,800 births. Etiology is diverse and associated conditions include cardiovascular malformations, chromosomal abnormalities, thoracic lesions, infections, metabolic disorders, fetal anemia and twinning. Overall prognosis is poor, with mortality between 50% and 98%. Advances in obstetric ultrasound and prenatal diagnosis have made it possible to diagnose a number of congenital anomalies early in gestation. In some cases, anatomic anomalies diagnosed in utero progress to nonimmune hydrops and almost certain fetal demise. It is these conditions that can be considered for fetal surgical intervention. This article reviews the pathophysiology and rationale behind surgical correction of two conditions that lead to hydrops: fetal thoracic lesions (congenital cystic adenomatoid malformation, pulmonary sequestration, and fetal pleural effusions) and sacrococcygeal teratoma (SCT).
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Affiliation(s)
- K M Bullard
- Fetal Treatment Center, University of California, San Francisco 94143-0570, USA
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26
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Beris P, Darbellay R, Extermann P. Prevention of beta-thalassemia major and Hb Bart's hydrops fetalis syndrome. Semin Hematol 1995; 32:244-61. [PMID: 8560282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- P Beris
- Division d'Hématologie et Clinique d'Obstétrique, Hôpital Cantonal Universitaire de Genève, Switzerland
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27
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Pászty C, Mohandas N, Stevens ME, Loring JF, Liebhaber SA, Brion CM, Rubin EM. Lethal alpha-thalassaemia created by gene targeting in mice and its genetic rescue. Nat Genet 1995; 11:33-9. [PMID: 7550311 DOI: 10.1038/ng0995-33] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Mutations at the alpha-globin locus are the most common class of mutations in humans, with deletion of all four adult alpha-globin genes resulting in the perinatal lethal condition haemoglobin Barts hydrops fetalis. Using gene targeting in mice, we have deleted a 16 kilobase region encompassing both adult alpha-globin genes. Animals homozygous for this deletion become hydropic and die late in gestation mimicking humans with hydrops fetalis. Introduction of a human alpha-globin transgene rescued these animals from perinatal death thus demonstrating the utility of this murine model in the development of cellular and gene based approaches for treating this human genetic disease.
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Affiliation(s)
- C Pászty
- Human Genome Center, Lawrence Berkeley Laboratory, University of California, Berkeley 94720, USA
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28
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Roberts A. Systems of life. Blood: 5. Nurs Times 1994; 90:39-42. [PMID: 7971374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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29
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MESH Headings
- Adult
- Amniocentesis
- Anemia, Neonatal/etiology
- Anemia, Neonatal/history
- Anemia, Neonatal/prevention & control
- Anemia, Neonatal/therapy
- Antibodies, Monoclonal/therapeutic use
- Blood Transfusion, Intrauterine
- Erythroblastosis, Fetal/etiology
- Erythroblastosis, Fetal/history
- Erythroblastosis, Fetal/prevention & control
- Erythroblastosis, Fetal/therapy
- Female
- History, 20th Century
- Humans
- Hydrops Fetalis/etiology
- Hydrops Fetalis/history
- Hydrops Fetalis/prevention & control
- Hydrops Fetalis/therapy
- Immunoglobulins
- Infant, Newborn
- Labor, Induced
- Pregnancy
- Rh Isoimmunization/prevention & control
- Rh Isoimmunization/therapy
- Rh-Hr Blood-Group System/genetics
- Rh-Hr Blood-Group System/history
- Rh-Hr Blood-Group System/immunology
- Rho(D) Immune Globulin
- United Kingdom
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Affiliation(s)
- L A Tovey
- Yorkshire Regional Transfusion Centre, Leeds, U.K
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30
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Mallmann P, Gembruch U, Mallmann R, Hansmann M. Investigations into a possible immunological origin of idiopathic non-immune hydrops fetalis and initial results of prophylactic immune treatment of subsequent pregnancies. Acta Obstet Gynecol Scand 1991; 70:35-40. [PMID: 1858493 DOI: 10.3109/00016349109006175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The cause of the non-immune hydrops fetalis (NIHF) remains unsettled despite all efforts. From the immunological point of view of pregnancy as a successful course of an allograft, it would seem possible that the idiopathic NIHF can be caused by an immunologic disorder in the meaning of a host-versus-graft reaction. Of 324 cases of prenatally diagnosed NIHF, 49 (15.1%) could be classified after exclusion of all other causes as idiopathic and in 38 patients, as well as in 38 age- and parity-paired controls, a differentiation of HLA-antigens and a determination of lymphocytotoxic antibodies using the NIH Prolonged Incubations and Cold-Complement-Dependent Cytotoxicity Test (CoCoCy Test) were performed. In cases of idiopathic NIHF, the proportion of parents sharing 4 or 5 HLA antigens was increased significantly (p less than 0.05) compared with the control group. In women with idiopathic NIHF, the incidence of lymphocytotoxic antibodies was decreased, due to the test system used; between 28 and 68% in the NIHF group and 24-80% in the control group. The proportion of women without lymphocytotoxic antibodies was increased in the NIHF group by 72% to 52%, whereas in the control group, in none of the patients could a higher cytotoxicity with a lysing rate of more than 75% be detected. In 8 cases of idiopathic NIHF, where an increased paternal histocompatibility and a decreased incidence and percentage of lymphocytotoxic antibodies were determined, an immunotherapy was performed in order to induce maternal blocking antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Mallmann
- Department of Gynecology and Obstetrics, University of Bonn, Germany
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31
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Rodis JF, Quinn DL, Gary GW, Anderson LJ, Rosengren S, Cartter ML, Campbell WA, Vintzileos AM. Management and outcomes of pregnancies complicated by human B19 parvovirus infection: a prospective study. Am J Obstet Gynecol 1990; 163:1168-71. [PMID: 2171338 DOI: 10.1016/0002-9378(90)90681-v] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During a large statewide outbreak of fifth disease in Connecticut in 1988, 39 pregnant women were identified who had serologic evidence of recent human B19 parvovirus infection. The patients were followed up prospectively with targeted fetal ultrasonographic examinations to detect signs of fetal hydrops. Of these 39 pregnant women, 37 had healthy infants and two patients had miscarriages. None of the fetuses developed hydrops. We propose that pregnant women exposed to B19 parvovirus be tested for evidence of IgG and IgM B19-specific antibodies and that targeted fetal ultrasonography be considered when IgM antibodies are found. Percutaneous umbilical blood sampling and intrauterine transfusion can be considered in cases of B19 parvovirus-associated hydrops and anemia. The overall fetal loss rate in this prospective follow-up group was 5%.
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Affiliation(s)
- J F Rodis
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06032
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32
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MESH Headings
- Blood Transfusion, Intrauterine/adverse effects
- Blood Transfusion, Intrauterine/methods
- Canada/epidemiology
- Erythroblastosis, Fetal/diagnosis
- Erythroblastosis, Fetal/epidemiology
- Erythroblastosis, Fetal/immunology
- Erythroblastosis, Fetal/therapy
- Exchange Transfusion, Whole Blood
- Female
- Fetal Blood/immunology
- Fetal Death/etiology
- Humans
- Hydrops Fetalis/etiology
- Hydrops Fetalis/mortality
- Hydrops Fetalis/prevention & control
- Immunoglobulins, Intravenous/therapeutic use
- Immunosuppression Therapy
- Infant, Newborn
- Kernicterus/etiology
- Kernicterus/mortality
- Kernicterus/prevention & control
- Labor, Induced
- Male
- Plasma Exchange
- Predictive Value of Tests
- Pregnancy/immunology
- Prenatal Diagnosis
- Prevalence
- Rh Isoimmunization/complications
- Rh Isoimmunization/epidemiology
- Rh Isoimmunization/therapy
- Rh-Hr Blood-Group System/immunology
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Affiliation(s)
- J M Bowman
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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33
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Abstract
This paper reviews 47 series of hydrops fetalis (804 cases) and 610 individual cases published since 1980. From this large number of cases, guidelines are derived for prenatal diagnosis and management.
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Affiliation(s)
- G A Machin
- Department of Pathology, University of Alberta Hospital, Edmonton, Canada
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34
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Mallmann P, Gembruch U, Mallmann R, Hansmann M. [A possible "immunologic" origin of idiopathic non-immunologic hydrops fetalis and initial results of preventive immunotherapy of subsequent pregnancies]. Z Geburtshilfe Perinatol 1989; 193:161-6. [PMID: 2800657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The cause of the nonimmune hydrops fetalis remains unsettled in spite of greatest efforts. Under an immunologic point of view of pregnancy as a successful course of an allograft it seems possible, that the idiopathic NIHF can be caused by an immunologic disorder in the meaning of a host-versus-graft-reaction. From 300 cases with prenatal diagnosed NIHF 37 (12.4%) could be classified after exclusion of all other causes as idiopathic and in 25 patients, as well as in 25 age- and parity-paired controls a differentiation of HLA-antigens and a determination of lymphocytotoxic antibodies using the NIH-, Prolonged incubation- and Cold-Complement Dependent-Cytotoxicity-Test (CoCoCy-Test) were performed. In cases with idiopathic NIHF the percentage of parents sharing 4 or 5 HLA-antigens was increased with 4/25 to 2/25 compared to the control group. In women with idiopathic NIHF the incidence of lymphocytotoxic antibodies was decreased, in dependence of the test-system used between 28 and 68% in the NIHF group and 24 and 80% in the control group. The percentage of women without lymphocytotoxic antibodies was increased in the NIHF group with 72% to 52%, in opposite to the control group in none of the patients a higher cytotoxicity with a lysing rate of more than 75% could be detected. In 4 cases with idiopathic NIHF, an increased paternal histocompatibility and a decreased incidence and percentage of lymphocytotoxic antibodies an immunotherapy was performed, in order to induce maternal blocking antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Mallmann
- Zentrum für Frauenheikunde und Geburtshilfe der Universität, Bonn
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