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Hydropic Fetuses (hydropic + fetuse)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy?

PRENATAL DIAGNOSIS, Issue 2 2003
Jean-Marie Jouannic
Abstract Objective The aim of this study was to evaluate the role of amiodarone for the prenatal treatment of hydropic fetuses with supraventricular tachycardia. Methods A group of 26 hydropic fetuses with supraventricular tachycardia was studied retrospectively. Results Twenty-five fetuses received transplacental treatment. The overall prenatal conversion rate was 60%. Nine fetuses were converted to sinus rhythm using either flecainide (n = 7) or amiodarone (n = 2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first-line therapy, supraventricular tachycardia persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second-line therapy, five of whom were converted to sinus rhythm. Among the 11 live neonates treated by amiodarone in utero, 2 (17%) presented an elevated thyroid stimulating hormone at day 3,4. These two infants received thyroid hormone substitution therapy and had a normal outcome. Conclusion When first-line therapy fails to restore sinus rhythm in hydropic fetuses with supraventricular tachycardia, amiodarone therapy should be considered as it allows a substantial number of fetuses to be converted prenatally. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Human parvovirus B19 infection in pregnancy: should screening be offered to the low-risk population?

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2002
Wong Shell Fean
ABSTRACT Human parvovirus B19 infection during pregnancy can result in fetal hydrops and death. Intra-uterine transfusion in hydropic fetuses affected by the virus can reduce perinatal deaths. Up to 33% of women with this infection are asymptomatic. In view of the significant adverse outcomes, the role of routine screening among low-risk pregnant women is discussed. [source]

Thrombocytopenia in hydropic fetuses with parvovirus B19 infection: incidence, treatment and correlation with fetal B19 viral load

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2008
TR De Haan
Objective, To examine (1) the incidence of fetal thrombocytopenia in hydropic fetuses with congenital B19 virus infection, (2) the effect of intrauterine platelet transfusions and (3) the correlation between fetal B19 viral load and severity of thrombocytopenia. Design, Retrospective analysis of data from prospectively collected fetal blood samples. Setting, Leiden University Medical Centre, the national centre for management of intrauterine fetal disease in the Netherlands. Population, Thirty hydropic fetuses treated with intrauterine red blood cell and platelet transfusions for human B19 virus-induced severe fetal anaemia and thrombocytopenia over a 10-year period. Methods, Fetal blood samples (n= 30) taken before and after intrauterine transfusion were investigated. No cases were excluded, and there was no loss to follow up. Main outcome measures, Parameters recorded were gestational age, experienced fetal movements, gravidity and parity, severity of fetal hydrops, severity of fetal anaemia and thrombocytopenia and megakaryocyte and reticulocyte counts. Survival and procedure-associated complications were documented. Quantitative B19 viral load measurements were performed on all fetal samples. Results, Forty-six percent of all hydropic fetuses showed severe thrombocytopenia. No antenatal intracerebral haemorrhage or procedure-associated bleeding occurred. Overall, survival was 77%. Platelet counts increased following platelet transfusion and decreased significantly following red blood cell transfusion alone. No correlation was found between fetal viral loads and platelet counts. Conclusion, Thrombocytopenia was frequently encountered in fetal B19V infection, but fetal bleeding complications were not noted. Absence of a direct relationship between fetal B19 viral load and platelet counts suggests a temporal dissociation between these findings. Dilutional thrombocytopenia is frequently seen in the fetus following red blood cell transfusion alone. The clinical significance of this phenomenon is unclear. The risk of fluid overload by fetal platelet transfusion in a severely hydropic fetus should be weighed against the low incidence of fetal bleeding complications. [source]

A new method to determine the feto-placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2002
M. Hoogeveen
Objectives (1) To calculate the feto-placental volume (FPV), using the haematocrit (Ht) values and the percentages of fetal haemoglobin (HbF), before and after red blood cell transfusion. (2) To estimate the transfusion-induced loss of plasma fluid. Design Retrospective analysis of data of 42 anaemic fetuses at the first transfusion [gestational age (GA) 19,36 weeks]. Setting Department of Obstetrics, Leiden University Medical Centre, The Netherlands. Sample Fifteen hydropic and 27 non-hydropic fetuses. Methods Donor blood volume (Vdonor) and Ht (Htdonor), fetal pre- and post-transfusion Ht values (Htinitial, Htfinal) and percentages of HbF (HbFinitial and HbFfinal) were used to calculate the FPV. The total red cell volume after transfusion (RCVfinal) and Htfinal were used to estimate the plasma fluid loss. Main outcome measures Feto-placental blood volume and loss of plasma fluid. Results The equations that use Htfinal over-estimate the FPV when the formula does not account for the difference between donor and post-transfusion Ht (FPVHt= 21.36 * GA , 390; r= 0.89). FPV is under-estimated (FPVHt= 9.90 * GA , 172; r= 0.84) when the blood volume increases with a volume less than the added donor blood volume. The calculation of FPV, using HbF percentages and the initial fetal RCV, is independent of volume changes (FPVHbF= 15.10 * GA , 279; r= 0.85). Comparing RCVfinal and Htfinal values showed that 31.1 ± 14.5% of the transfused volume was lost. Results of the hydropic fetuses did not differ from those of the non-hydropic fetuses. Conclusions FPV values based on Ht values are less reliable than those based on RCV and HbF findings. When, for practical reasons, Ht values have to be used, we propose an adapted equation for the calculation of the necessary volume of donor blood: Vdonor= FPVHbF* (Htfinal, Htinitial) / (Htdonor, 0.70 * Htfinal). [source]