Extended matched intrauterine transfusions reduce maternal Duffy, Kidd, and S antibody formation.

Background: Severe alloimmune hemolytic disease of the fetus is treated with intrauterine transfusions (IUTs). Despite C, c, E, e, and K matching between mother and donor, IUT results in new antibodies in approximately 25% of women. Newly formed Fy(a), Fy(b), Jk(a), Jk(b), and S antibodies are in 83% presumably induced by the IUT donor.

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Term perinatal mortality and morbidity in monochorionic and dichorionic twin pregnancies: a retrospective study.

Aim: Perinatal mortality and morbidity in monochorionic (MC) twins appears to be increasing compared to dichorionic (DC) twins. The aim of our study was to determine the difference in perinatal mortality and morbidity in MC and DC twins born after 37 weeks' gestation.

Design: A retrospective, cross-sectional study of medical records.

Implementation of routine screening for Kell antibodies: does it improve perinatal survival?

Background: In 1998 a national program for first-trimester screening for red cell (RBC) antibodies in all pregnant women was implemented. The aim of our study was to assess the impact on perinatal mortality caused by Kell alloimmunization

Study Design And Methods: Prospectively collected data on all pregnant women referred to our center from 1988 until 2005 for intrauterine transfusion (IUT) for fetal anemia due to Kell alloantibodies were analyzed. The cohort was divided into two groups, those treated before 1998 and those treated after 1998.

Obstetric history and antibody titer in estimating severity of Kell alloimmunization in pregnancy.

Objective: To evaluate the usefulness of the obstetric history and the maternal serum Kell antibody titer in the management of pregnancies with Kell alloimmunization.

Methods: In a retrospective cohort study of 41 pregnancies complicated by Kell alloimmunization, the obstetric history, divided into presence or absence of a previous Kell-positive child, and Kell antibody titers in the index pregnancy were correlated with the gestational age at the onset of fetal anemia.

Results: Women with a previous Kell-positive child had a lower gestational age at the first intrauterine transfusion compared with those without a previous Kell-positive child (P=.

Hypoalbuminemia: a cause of fetal hydrops?

Objective: The pathophysiology of fetal hydrops is still unclear. One factor that is believed to contribute to hydrops is hypoalbuminemia. Our research question was whether hypoalbuminemia in immune hydrops is causative or a secondary effect.

Obstetric intensive care admissions: a 12-year review in a tertiary care centre.

Objective: To review all pregnant women who required admission to an Intensive Care Unit (ICU) during pregnancy, childbirth or puerperium.

Study Design: Retrospective follow-up study in a tertiary care centre in The Netherlands. The files of all obstetric ICU admissions over the period 1990-2001 were reviewed.

Fetal cardiac contractility before and after intrauterine transfusion.

Objective: To evaluate the effect of fetal anemia and intrauterine transfusion on ventricular shortening fraction.

Methods: The end-diastolic and end-systolic transverse dimensions of the left and right ventricles were obtained using M-mode ultrasonography. The shortening fractions of both ventricles were calculated at three time points: before, immediately after and one day after intrauterine transfusion.

Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization.

Objective: The purpose of this study was to establish the true procedure-related complication rate of intrauterine transfusion therapy.

Study Design: A cohort study of 254 fetuses treated with 740 intrauterine blood transfusions for red-cell alloimmunization in a single center in the years 1988 to 2001. Our database was searched for perinatal deaths, emergency deliveries, infections, and preterm rupture of membranes associated with intrauterine blood transfusion.

Treatment of fetal anemia due to red-cell alloimmunization with intrauterine transfusions in the Netherlands, 1988-1999.

Objective: To assess pregnancy outcome after intrauterine transfusion (IUT) for fetal anemia due to red-cell alloimmunization in the Netherlands over 11 years, in order to improve care and counseling.

Methods: A retrospective cohort study was conducted from January 1, 1988, to January 1, 1999. Data were collected prospectively on all red-cell alloimmunized pregnancies requiring intrauterine blood transfusions.

Effect of an increase of the hematocrit on middle cerebral artery peak and umbilical vein maximum velocities in anemic fetuses.

Objective: To measure the effects of acute large increases of the hematocrit on fetal peak arterial and maximum venous blood flow velocities.

Methods: Middle cerebral artery peak flow velocities and umbilical vein maximum flow velocities were measured before, immediately after, and 12-24 h after intrauterine transfusions. All measurements were standardized for gestational age.

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.

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].

Amniotic fluid delta OD 450 values accurately predict severe fetal anemia in D-alloimmunization.

Objective: To assess the diagnostic accuracy of amniotic fluid Delta OD 450 values in the second and third trimesters of D-alloimmunized pregnancies.

Methods: We searched our database for singleton D-alloimmunized pregnancies with nonhydropic fetuses, where amniocentesis was performed within 4 days of first fetal blood sampling. Amniotic fluid Delta OD 450 values were plotted on an extrapolated Liley's chart.

The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment.

Objective: This study was undertaken to test the hypothesis that the degree of immune fetal hydrops predicts outcome in red blood cell-alloimmunized pregnancies.

Study Design: In an 11-year period, 213 fetuses received 599 intrauterine transfusions. The outcome of 208 pregnancies, including two pairs of twins, was analyzed in a retrospective study.

Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.

Objective: To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation.

Setting: National referral center for intrauterine treatment of red-cell alloimmunization in The Netherlands.

Study Design: Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs.

[Blood group immunization: results of treatment of fetal anemia with intra-uterine intravascular blood transfusion in the Netherlands, 1987-1995].

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.

Intrauterine transfusions influence fetal leukocyte counts and subsets.

The objective of this study was to determine the effect of intravascular intrauterine transfusion (IUT) on fetal leukocyte counts and subsets. For this purpose, pre- and post-transfusion blood samples of 81 fetuses, receiving a total of 253 IUTs, were compared. Immediately after the IUT procedure an average decrease in fetal leukocyte count of 4 per cent was observed.

The disappearance of fetal and donor red blood cells in alloimmunised pregnancies: a reappraisal.

Objective: To determine the proportional reduction per day in the number of fetal and donor red blood cells from the fetal circulation after intrauterine intravascular transfusions.

Design: A retrospective study of 302 transfusions in 101 fetuses.

Setting: The Department of Obstetrics and Gynaecology of the University Medical Centre Leiden, The Netherlands.

Antenatal care in pregnancies at risk of alloimmune thrombocytopenia: report of 19 cases in 16 families.

Objective: To assess accuracy of a management program in patients at risk for alloimmune thrombocytopenia (NAITP) and to describe perinatal outcomes.

Study Design: Nineteen fetuses at risk of thrombocytopenia were identified using obstetric history, HLA type of the mother and fetal phenotyping in cases where paternal heterozygozity for the offending antigen was present. Cordocentesis was timed according to obstetric history and performed with safety precautions to prevent haemorrhage.

The use of ultrasonography and Doppler in the prediction of fetal haemolytic anaemia: a multivariate analysis.

Objective: To assess the value of ultrasonography and Doppler to predict the severity of fetal haemolytic anaemia.

Design: Ultrasonographic measurements of the fetal liver, spleen, umbilical vein and placenta, and Doppler measurements of umbilical venous and fetal aorta flow velocities were performed before the first intrauterine blood transfusion. Multivariate regression models for the prediction of the fetal haemoglobin level were derived from the measurements.

Ultrasonographic fetal spleen measurements in red blood cell-alloimmunized pregnancies.

Objectives: This study was performed to evaluate the possible relationship between fetal spleen size and fetal hemoglobin levels and to assess the predictive value of ultrasonographically measured fetal spleen size as an estimate of the severity of fetal hemolytic anemia.

Study Design: Before 85 consecutive fetal blood samples in 28 red blood cell-alloimmunized pregnancies ultrasonographic fetal spleen measurements were performed. Results were compared with our own longitudinally derived reference ranges and were correlated with fetal hemoglobin deficit.

Fetal and neonatal cerebral blood velocity in the normal fetus and neonate: a longitudinal Doppler ultrasound study.

In a longitudinal Doppler ultrasound study fetal and early neonatal cerebral blood flow velocities were assessed in the middle cerebral artery in 40 uncomplicated pregnancies during the third trimester of pregnancy and in 22 neonates born from these pregnancies. Peak systolic (PSFV), temporal mean (TMFV), and end diastolic flow velocities (EDFV) were determined and pulsatility index (PI = (PSFV - EDFV)/TMFV) and Pourcelot's resistance index (RI = (PSFV - EDFV)/PSFV) calculated. PSFV, TMFV and EDFV increased during the third trimester of pregnancy and were significantly higher from 36 weeks of gestation onward as compared to values obtained at 28 weeks of gestation, suggesting an increase in actual cerebral blood flow.

Management of severe hemolytic disease with ultrasound-guided intravascular fetal transfusions.

Between January 1987 and March 1989, 22 fetuses with severe hemolytic disease were treated with 64 ultrasound-guided intrauterine intravascular transfusions. Eighteen infants survived and are doing well. In 12 fetuses, hydropic changes were present at the first transfusion; 9 of these survived.