ultrasound diagnosis of fatal anomalies

FETAL HYDROPS
constant, determination of the blood group and
extinction measurements using amniotic fluid at
26 weeks may be a useful examination. Monitoring
the pregnancy using Doppler flow imaging
alone has not yet been sufficiently evaluated.
The main disadvantage of repeated invasive procedures
is the risk of boosting and thus worsening
the initial condition.
Intrauterine transfusions of erythrocytes
through the umbilical vein are indicated if the
hemoglobin value falls below 8–10 g% (erythrocyte
concentrate: O rhesus-negative, hematocrit
70%, cytomegalovirus-negative, irradiated to reduce
the graft-versus-host reaction). The transfusion
can be facilitated by administration of
pancuronium (0.3 mg/kg estimated fetal weight)
to relax the fetus. Once the transfusion has been
carried out, repeated transfusions are usually required
at 2–3-week intervals. The transfused erythrocytes
cannot be destroyed by maternal antibodies,
as they are O rhesus-negative.
However, fetal erythropoiesis is suppressed due
to these transfusions, so that at birth the percentage
of erythrocytes in fetal blood with adult
hemoglobin is almost 100%. If the transfusions
are well tolerated, the pregnancy can be prolonged
up to 37 weeks. In the absence of severe
anemia and fetal hydrops, vaginal delivery is attempted.
Prognosis: The rate of survival after adequate
therapy is 95%, and in case of hydrops 80–85%.
References
Andersen AS, Praetorius L, Jorgensen HL, Lylloff K, Larsen
KT. Prognostic value of screening for irregular antibodies
late in pregnancy in rhesus positive women.
Acta Obstet Gynecol Scand 2002; 81: 407–11.
Dimer JA, David M, Dudenhausen JW. Intravenous drug
abuse is an indication for antepartum screening for
RH alloimmunization: a case report and review of
literature. Arch Gynecol Obstet 1999; 263: 73–5.
Hohlfeld P, Wirthner D, Tissot JD. Perinatal hemolytic
disease, 2: prevention and management. J Gynecol
Obstet Biol Reprod (Paris) 1998; 27: 265–76.
Holzgreve W, Zhong XY, Burk MR, Hahn S. Enrichment
of fetal cells and free fetal DNA from maternal blood:
an insight into the Basel experience. Early Pregnancy
2001; 5: 43–4.
Moise KJ Jr. Management of rhesus alloimmunization in
pregnancy [review]. Obstet Gynecol 2002; 100: 600–
11.
Müller HI, Hackelber BJ, Kattner E. Pre- and postnatal diagnosis
and treatment of hydrops fetalis: an interdisciplinary
problem. Z Geburtshilfe Neonatol 1998;
202: 2–9.
Steiner EA, Judd WJ, Oberman HA, Hayashi RH, Nugent
CE. Percutaneous umbilical blood sampling and
umbilical vein transfusions: rapid serologic differentiation
of fetal blood from maternal blood. Transfusion
1990; 30: 104–8.
Whitecar PW, Depcik-Smith ND, Strauss RA, Moise KJ.
Fetal splenic rupture following transfusion. Obstet
Gynecol 2001; 97: 824–5.
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Procedure after birth: Neonatal jaundice is seen
frequently. Exchange transfusion is necessary if
severe anemia and fetal hydrops are present.
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