Fetal Intravascular Transfusion for Severe Erythroblastosis: Effects on Haematology and Survival

Since February 1984, 8 fetuses (including a set of hydropic twins) with severe erythroblasts in the second trimester have received intravascular transfusions guided by ultrasound. These transfusions were associated with a decreasing fetal reticulocytosis, a decreasing proportion of circulating fetal haemoglobin and a decreasing mean fetal red corpuscular volume. All infants were born alive at an average of 5.5 weeks after the first transfusion; 3 infants died, including the hydropic twins and another with lethal congenital anomalies. All 5 survivors required simple transfusions for up to 54 days after birth because of prolonged bone marrow suppression. In severe erythroblastosis in the second trimester, direct intravascular transfusion using ultrasound guidance promises to improve fetal outcome.     

静脉扩容治疗胎儿生长受限临床疗效观察

目的应用静脉输液扩容治疗胎儿生长受限(FGR)并观察其疗效。方法治疗组37例,对照组22例,测定治疗前后的宫高、腹围、胎儿双顶径,以及出生后的新生儿体重及胎盘重量。结果治疗组上述各指标均高于对照组,P<0.05;两组低体重儿发生率及早产率存在统计学差异,P<0.05。结论静脉扩容能有效地治疗FGR,改善胎儿宫内生长发育状况。     

Development of a Training Model for Teaching Intrauterine Fetal Blood Transfusion

This article describes an inexpensive simulator developed for teaching intrauterine blood transfusion. The model is constructed from a boneless chicken thigh folded over a Penrose drain placed in a water-filled snap-lock lid container and covered by melted ballistic gel to simulate the fetal intrahepatic vessel. Participants valued this educational tool and reported feeling the model was practical and realistic. This low-cost, high-fidelity model provides realistic tissue resistance and represents a sonographically accurate intrahepatic fetal blood transfusion training tool.     

Indications for Blood Transfusion in Pregnancy With Sickle Cell Disease

EDITORIAL COMMENT": These authors have previously reported the importance of sickle cell anaemia as a cause of maternal mortality in Bahrain (A). We have accepted this paper for publication although sickle cell anaemia is rare in Australia so that our readers can see the lesson learnt from this very large experience of 571 cases, namely that prophylactic blood transfusion is not indicated unless the haemoglobin value falls below 6 g/dL. We presume that all of these patients would require blood to be cross-matched and available at delivery in case of postpartum haemorrhage.
Summary: In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups.
A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well-being with an additional benefit of reducing the incidence of transfusion related crises and other complications.     

机械通气对新生儿血浆中抗氧化酶活性的影响

目的　探讨机械通气对新生儿血浆中抗氧化酶 (antioxidant enzyme,AOE)活性的影响。　方法　用酶活性测定法检测 72例新生儿机械通气前后血浆中过氧化氢酶 (catalase,CAT)、谷胱甘肽过氧化物酶 (glutathione peroxidage,GPX)和超氧化物歧化酶 (superoxide dism utase,SOD)的活性。　结果　 (1)机械通气前 ,早产儿与足月儿 ,低出生体重儿与正常出生体重儿血浆 GPX分别为(90± 6 1)、(116± 5 1)、(94± 6 1)、(113± 5 2 ) k U/ L,CAT分别为 (6 8± 43)、(82± 43)、(6 9± 41)、(84±43) k U/ L,差异无显著性 (P>0 .0 5 ) ,而 SOD在早产儿和低出生体重儿较低 [分别为 (78± 11)、(84±11) k U/ L(P<0 .0 5 )。(2 )机械通气后 ,各组 GPX、CAT、SOD均随通气时间的延长而下降 ,但足月儿、正常体重儿下降幅度较小 ,而早产儿、低出生体重儿下降幅度较大。通气后 3d GPX、CAT、SOD在早产儿分别为 (72± 47)、(5 1± 33)、(5 3± 9) ,足月儿分别为 (10 2± 49)、(78± 37)、(87± 11) ,低出生体重儿分别为 (70± 48)、(4 9± 31)、(5 1± 9) ,正常出生体重儿分别为 (10 3± 47)、(74± 2 3)、(85± 12 ) k U/L,早产儿低于足月儿 ,低出生体重儿各项均低于正常出生体重儿 (P<0 .0 1)。　结论　机械通气可降低新生     

绝经妇女血浆一氧化氮、内皮素的水平及补充性激素后的变化

目的 探讨绝经妇女雌激素下后血浆一氧化氮（ＮＯ）与内皮素（ＥＴ）水平的变化,及服用结合雌激素加安宫黄体酮对ＮＯ、ＥＴ水平的影响。方法 选择７０例绝经妇女作为绝经组,２８例有围绝经期症状的妇女作为围绝经组,２６例月经周期正常的妇女作为正常月经组。绝经组中３０例服用结合雌激素加安宫黄体酮者为绝经１组,另外２０例服用碳酸钙治疗者为绝经２组,绝经１期及绝经２组用药时间均为６个月。以上各组均取静脉血测定ＮＯ     

胰岛素样生长因子 -Ⅰ与胎儿出生体重的关系

目的了解胰岛素样生长因子Ⅰ（ＩＧＦⅠ）在胎儿生长发育中所起的作用。方法选择１７１例产妇及其所分娩的新生儿１６４例，根据出生体重将新生儿分为大于胎龄儿（ＬＧＡ）组：产妇７７例、新生儿６４例；适于胎龄儿（ＡＧＡ）组：产妇５９例、新生儿５９例；小于胎龄儿（ＳＧＡ）组：产妇３５例、新生儿４３例。用放射免疫法测定血清中ＩＧＦⅠ的浓度。结果母血中ＩＧＦⅠ浓度均高于脐血，两者间存在浓度梯度（Ｐ＜０．０１）；母、脐血中ＩＧＦⅠ浓度随孕周增加，至３９～４０周达顶峰；３３～４０周间除ＳＧＡ组外，血中ＩＧＦⅠ浓度与新生儿出生体重呈正相关（ｒ＝０．９１～０．９８）；ＳＧＡ组母、脐血ＩＧＦⅠ浓度与ＡＧＡ组相比，均有不同程度降低（Ｐ＜０．０１）。结论母、儿的ＩＧＦⅠ分泌系统相对独立。ＩＧＦⅠ是调节胎儿生长发育的重要生长因子之一。     

雄性恒河猴外周血中睾酮分泌水平

本文采用放射免疫测定法，测定了４２只雄性恒河猴外周血中睾酮的含量。结果表明，不同年龄阶段的雄性恒河猴睾酮分泌水平有显著的差异，幼年组、成年组和老年组的雄猴外周血中睾酮含量分别为：２．３±１．２ｎｇ／ｍｌ、８．６±２．４ｎｇ／ｍｌ和２．４±１．６ｎｇ／ｍｌ．提示睾酮含量可能因性功能的年龄改变而呈现出显著的差别。     

The Effect of Hypertension on Fetal Growth

To assess the effect of hypertension on fetal growth we studied all hypertensive patients who delivered at the University Hospital “Wilhelmina Gasthuis”, Amsterdam, over a five-year period. They were studied on a retrospective basis. Patients were excluded from this study if they had a multiple pregnancy or a hydatidiform mole. Out of 7454 women who delivered after 28 weeks gestation between 1975 and 1981, 716 nulliparae (N.P.) and 489 multiparae (M.P.) had a diastolic bloodpressure of ≥ 90 mm on at least two occasions. They were matched for age and parity with a normotensive control group, who delivered at our University Hospital in the same period. The Small-for-Gestational-Age (SGA) infant was designated as one whose birthweight fell below 5th percentile. Only the maximum diastolic bloodpressure level proved to have an association with the incidence of SGA infants. The influence of proteinuria appeared to be of minor importance with respect to fetal growth retardation when maximum diastolic bloodpressure levels were standardized.     

Intravascular Coagulation in Uterine Venous Blood of Toxemic Patients

Coagulation profile was investigated in blood drawn from the uterine vein of 12 patients undergoing cesarean section for moderate to moderately severe preeclampsia, and blood drawn peripherally at the same time. An identical study was made in a control group of 12 nontoxemic patients undergoing routine repeat cesarean section. In the control group, platelet counts and fibrinogen levels were always within normal limits, and there was no major difference between peripheral and uterine vein blood; fibrin degradation products (FDP) were uniformly absent. Compared to control patients, the preeclamptic patients showed in the peripheral blood drops in the platelet counts of 17 percent and in fibrinogen level of 5 percent, and in the uterine venous blood drops in the platelet counts of 43 percent and in fibrinogen level of 18 percent. FDP were present once in the peripheral blood and three times in the uterine venous blood. It appears that when blood passes through the toxemic placenta first there is consumption of thrombocytes, second fibrinogen to fibrin conversion, and then FDP formation.     

胎儿声振动刺激反应的研究

目的：了解不同孕龄胎儿对声振动刺激的反应。方法：对４３５例次正常中、晚期妊娠妇女进行声振胎心试验（ＶＡＳ－Ｔ）、声振胎动试验（ＳＰＦＭ），并对声振动刺激前、后胎心率变化规律进行前瞻性研究。结果：（１）从２４周开始，胎儿对声振刺激有反应，但大部分未能达到ＶＡＳ－Ｔ诊断标准，而胎动反应良好。（２）妊娠２８周开始，声振刺激后，９０％以上的胎儿出现显著的胎动、胎心率加速反应，足月胎儿反应率在９８％以上。（３）ＳＰＦＭ阳性率的显著提高早于ＶＡＳ－Ｔ。提示：２８周后胎儿神经系统发育已趋完善。胎儿运动神经的发育成熟早于植物神经。     

The Application of the Kleihauer Technique to Fetal Blood

An acid elution technique, when applied to fetal blood, demonstrated completely eluted or "adult" erythrocytes as early as the twelfth week of gestation. In the third trimester the proportion of completely eluted cells varied from approximately 1% at 32 weeks to 2% at term. These results form a baseline for the use of the method as an accurate and rapid means of assessing the donor erythrocyte content of cord blood in babies born after intrauterine transfusion.     

孕妇血浆中胎儿DNA含量与早产关系的研究

目的:研究早产和先兆早产孕妇血浆胎儿DNA的含量以及临床意义.方法:选择孕满28周至不足37周出现自发性规律宫缩的孕妇(单男胎)51例,其中23例孕周<37周分娩为早产组;28例出现有威胁的早产宫缩但经抑制宫缩治疗后足月产为先兆早产组,另选择正常妊娠的孕妇25例为正常对照组.采用实时荧光定量PER方法测定孕妇血浆中总DNA和胎儿DNA的量,非参数统计方法进行数据分析.结果:①早产组孕妇血浆总DNA量中位数7639.0拷贝/ml高于正常对照组6931.8拷贝/ml,差异有统计学意义(P<0.05);②早产组孕妇血浆胎儿DNA中位数为386.6拷贝/ml,先兆早产组为312.9拷贝/ml,均高于正常对照组230.5拷贝/ml,差异均有统计学意义(P<0.05);③以正常对照组孕妇血浆胎儿DNA量的第90百分位作为阳性预测值,早产组的阳性预测率为82.6%,先兆早产组为46.4%,差异有统计学意义(P<0.05).结论:早产孕妇血浆中胎儿DNA水平升高,观察孕妇血浆中胎儿DNA变化可有助于发现存在早产的可能,便于及时干预和处理.     

Fetal Rhesus D genotyping on amniocytes in alloimmunised pregnancies using fluorescence duplex polymerase chain reaction

Objective 1. To establish the reliability of fetal amniocyte Rhesus D (RhD) genotyping using fluorescence duplex polymerase chain reaction (PCR) and 2. to assess the potential clinical impact on management of alloimmunised pregnancies.
Design Multicentre observational study.
Setting Four departments of obstetrics and gynaecology in Germany.
Methods Fourty-four amniotic fluid samples were obtained by amniocentesis from a retrospective group of 27 RhD alloimmunised pregnancies and 15 samples from 14 women treated prospectively. Two RhD gene specific fragments (exon 7 and 10) were amplified using two separate fluorescence duplex PCR assays, and laser detected in an automated DNA sequence analyser.
Results Amplification of the Rh gene sequences was successful in all samples. PCR at the two RhD gene regions resulted in complete concordance. Genotyping correctly predicted the RhD status of all fetuses serotyped (   n = 41  ). After intrauterine transfusions, PCR identified the RhD type of two fetuses more accurately than serotyping. Earlier knowledge of a negative RhD status would have rendered unneccessary 12 amniocenteses in four fetuses of the retrospective study group, and pre- vented further invasive testing in one fetus treated prospectively. In the latter group, women with a positive fetal RhD genotype underwent intensive prenatal care including serial invasive monitoring and intrauterine treatment.
Conclusions Fetal RhD genotyping of amniocytes is a reliable technique with the potential to improve routine management of alloimmunised pregnant women.     

Systematic Review and Meta-Analysis of the Effect of Nutrients on Blood Lead Levels in Pregnancy

ObjectiveTo synthesize experimental and nonexperimental research on the relationship between nutrients and blood lead levels in pregnant women. We also performed a meta-analysis on a subgroup of studies on calcium and blood lead levels.Data SourcesPubMed, Embase, and CINAHL databases were searched in July 2019.Study SelectionWe included articles published in English in any year that reported the results of experimental or observational studies on the effect of nutrients on blood lead levels in pregnancy.Data ExtractionThree nurse reviewers extracted data and appraised the studies using tools from the Joanna Briggs Institute.Data Synthesis and Meta-AnalysisWe included 28 studies from 16 countries. Study authors examined 14 distinct nutrients, with calcium being the most frequent. The metaregression included nine analyses of the effect of calcium on blood lead levels and showed a small but significant inverse relationship. The quality of evidence for the effect of calcium on lead levels was high. Eleven analyses were related to the effect of iron on blood lead levels. The quality of evidence was high, and we found mostly negative associations between iron intake and blood lead levels. The quality of evidence for the remaining nutrients was moderate, with few significant findings.ConclusionTargeted nutritional interventions may be beneficial for pregnant women with current lead exposure or a history of elevated lead levels, particularly those with calcium- or iron-deficient diets. More rigorously designed studies are needed in this area.     

孕妇血浆中胎儿游离DNA测序在无创性产前检测中的应用

目的:探讨孕妇血浆胎儿游离DNA高通量测序(DNA测序)在无创产前检测中的应用价值。方法:对7561例唐氏筛查高风险孕妇行DNA测序,并行羊水细胞染色体核型分析确诊。结果:在7561例孕妇中,DNA测序异常40例,羊水细胞核型结果异常37例,DNA测序误诊3例。其中DNA测序检测到21-三体高风险25例,羊水细胞核型确诊24例;18-三体均为12例。DNA测序对于21-三体检测的敏感性和特异性分别为100.00%和99.98%,18-三体检测的敏感性和特异性均为100.00%。DNA测序的假阳性率为0.04%,假阴性率为0。结论:孕妇血浆胎儿游离DNA高通量测序是检测21和18-三体一种敏感性高和特异性强的新方法,在无创产前检测中有重要的实用价值。     

The Effect of Epidural Bupivacaine on the Fetal Electrocardiogram

Summary: Fetal electrocardiogram waveform analysis was used to assess the effect of epidural bupivacaine on the fetal myocardial conducting system by evaluating its effect on the PR interval, RR interval, T/QRS ratio and the PR-RR correlation coefficient. There were no significant changes in either the PR interval or the PR-RR correlation coefficient. There was a significant increase in the fetal heart rate and a significant fall in the T/QRS ratio. Epidural bupivacaine does not alter fetal myocardial conduction as measured by the PR interval and it does not induce ischaemic cardiac changes as assessed by the T/QRS ratio.