Nonimmune hydrops fetalis caused by a massive fetomaternal hemorrhage associated with elevated maternal serum alpha-fetoprotein levels. A case report.

Chronic fetomaternal hemorrhage led to the development of fetal anemia and nonimmune hydrops fetalis in a term neonate. Antenatal maternal serum alpha-fetoprotein levels were abnormally elevated, with normal amniotic fluid levels. Kleihauer-Betke staining was performed as part of the evaluation. Serial ultrasound examinations can be useful for unexplained elevations in maternal serum alpha-fetoprotein because of the associated increased fetal loss in those pregnancies. If fetomaternal hemorrhage is identified, serial ultrasound examinations are indicated for the detection of fetal hydrops.     

Chronic, massive fetomaternal hemorrhage treated with repeated fetal intravascular transfusions

We report the first known case of chronic, massive fetomaternal hemorrhage managed by serial fetal intravascular transfusions. Timing of transfusions was guided by fetal heart rate patterns and fetal movement evaluation. Despite severe anemia and a sinusoidal heart rate pattern, the fetus demonstrated normal blood gases and no sign of hydrops.     

Successful in utero treatment of chronic and massive fetomaternal hemorrhage with fetal hydrops

BACKGROUND: Massive fetomaternal hemorrhage is an uncommon cause of chronic fetal anemia. Without treatment, hydrops fetalis can occur and progress toward death. In some cases, an early diagnosis can improve the management. CASE: A patient was found to have a fetus with non-immune hydrops related to massive and early fetomaternal hemorrhage successfully treated with serial fetal intravascular transfusion. After the treatment, ultrasonographic signs of hydrops disappeared and the pregnancy resulted in a good fetal outcome. There was no need for neonatal transfusion. Neurological examination at 1 month post-natal was normal. CONCLUSION: When massive fetomaternal hemorrhage is diagnosed early in the pregnancy, serial fetal intravascular transfusion may be an alternative to immediate delivery.     

Successful treatment of hydrops fetalis caused by fetomaternal hemorrhage: a case report

Nonimmune hydrops fetalis is a serious perinatal complication with diverse causes but few successful treatment modalities. The first reported case of hydrops fetalis caused by a massive fetomaternal hemorrhage treated successfully prenatally is presented. A modification of the standard intrauterine transfusion technique was used for therapy. Implications of future treatment are discussed.     

产后出血救治中大量输血方案

输血在抢救产后大出血患者中具有至关重要的作用。不恰当的大量输血可发生凝血功能障碍、低体温、酸中毒等并发症,甚至危及生命。大量输血方案的制定融合了多学科(手术科室、血液科、麻醉科、输血科、血库等)优势,可有效和高效地抢救患者,又可节省成本、降低输血风险、提高抢救成功率。     

Nonimmune hydrops fetalis due to congenital xerocytosis.

Hereditary xerocytosis is a rare hemolytic anemia in which erythrocytes are dehydrated due to a loss of potassium and water through their cell wall membrane. In adults, this condition leads to a mild-to-moderate hemolysis. We report a case of hydrops fetalis secondary to hereditary xerocytosis. Management with intrauterine erythrocyte and albumin transfusions resulted in a favorable postnatal course.     

Nonimmune hydrops fetalis: case reports and brief review.

We report two cases of nonimmune hydrops fetalis diagnosed prenatally. One fetus died in utero, and the second fetus survived and the infant was discharged from the intensive care nursery at 4 weeks of age. A brief review of the literature and the difficulties in arriving at a diagnosis and the management are described, along with certain prognostic factors determining the outcome.     

Nonimmune hydrops fetalis and fetal congenital syphilis. A case report.

Nonimmune hydrops fetalis occurred secondary to a syphilitic infection. Ultrasonographic evaluation and cordocentesis were used to confirm the antenatal infection. An IgM antibody specific for Treponema pallidum wall antigen (anti-47-kDa) was used to document the fetal infection. High-dose intravenous penicillin was administered in an attempt to achieve adequate fetal levels.     

Nonimmune hydrops fetalis: antenatal diagnosis and management

An 8-year (1975-1982) study of 26 cases of nonimmune fetal hydrops revealed the main causes to be: anomalies (11/26), tachyarrhythmias (4/26), and twin-to-twin transfusion (4/26). The perinatal mortality was 19/26 (76%). Based on this series, and a review of the literature, a plan for the antenatal diagnosis and management of these cases is outlined.     

Nonimmune hydrops fetalis associated with maternal infection with syphilis.

Intrauterine infection with syphilis was diagnosed by reactive maternal serologic studies, ultrasonographic findings, and exclusion of other causes in three hydropic fetuses at 31, 34, and 35 weeks' gestation. With penicillin therapy and preterm delivery all infants survived through the perinatal period. Intrauterine infection that follows syphilis is a potentially treatable cause of nonimmune hydrops.     

The reversal of hydrops fetalis by intravascular intrauterine transfusion in severe isoimmune fetal anemia

Seventy-two intrauterine intravascular transfusions were performed on 26 patients with severe erythroblastosis fetalis. Twenty of the 26 fetuses were hydropic at the time of referral. Of the 20 hydropic fetuses, 16 (80%) survived. Hydrops was completely reversed in 13 of the 16 fetuses (81%). Total protein of less than 3 gm/dl, albumin less than 2 gm/dl, and a hematocrit level of less than 15% were associated with hydrops fetalis. After hydrops was reversed, total protein greater than 3 gm/dl, albumin greater than 2 gm/dl, along with a sustained hematocrit level of greater than 15%, were found. Only three neonates were born with minimal ascites, two of whom had had intraperitoneal transfusions before intravascular treatments. There were 21 survivors of the total group, giving an overall survival rate of 82%. There was one neonatal death from severe respiratory distress syndrome. Thirty-eight percent of the neonates did not require exchange transfusions in the newborn period. Intrauterine intravascular transfusions appear to be an effective mode of therapy in severe erythroblastosis fetalis and not only increase survival rates but also decrease neonatal morbidity and mortality.     

Nonimmune fetal hydrops caused by bilateral type III congenital cystic adenomatoid malformation of the lung at 17 weeks' gestation.

Type III congenital cystic malformation of the lung with nonimmune hydrops and oligohydramnios was diagnosed at 17 weeks by ultrasonography. Massive fetal cardiac compression with probable associated left- and right-sided failure causing both the oligohydramnios and the ascites, respectively, was thought to be the underlying pathophysiologic mechanism of this unusual clinical presentation. Pathologic examination after termination of the pregnancy confirmed the prenatal diagnosis.     

Severe pre-eclampsia and HELLP syndrome after massive fetomaternal hemorrhage following blunt abdominal trauma

Severe pre-eclampsia and HELLP syndrome developed within 24 h after a 31 year old nulliparous woman suffered a blunt abdominal trauma with massive fetomaternal hemorrhage and fetal intracranial bleeding. This is the first case reported of fulminating pre-eclampsia and HELLP syndrome following maternal exposure to a large amount of fetal cells and/or fetal cell debris as DNA or microparticles.     

Postpartum hemorrhage: Blood product management and massive transfusion

Blood product transfusion capabilities are crucial for appropriate response to postpartum hemorrhage. Novel treatments are continually being sought to improve maternal morbidity and mortality associated with massive hemorrhage.