DIAGNOSIS AND TREATMENT OF HEMOLYTIC DISEASE OF THE FETUS


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Abstract

Objective. To analyze the authors’ results obtained over 10 years and to evaluate the efficiency of the introduced current methods for the prenatal diagnosis and treatment of hemolytic disease (HD) of the fetus. Subjects and methods. The study enrolled 358 pregnant women who were divided into 4 groups according to treatment policy: conservative management and intrauterine blood transfusion (IUBT) to the fetus, as well as to the used algorithm (in 1999—2005 when their medical history, antibodies, the presence of fetal dropsy were kept in mind and in 2006—2009 when the maximal blood flow velocity (MBFV) in the middle cerebral artery (MCA) becomes the basis of mon itoring. Results. Introduction of fetal monitoring based on MCA MBFV measurements could optimize obstetric tactics and significantly reduce the number of invasive diagnostic interventions (p < 0.001). There was evidence that IUBT was highly effective in the treatment of the severest edematous form of HD of the fetus. Isoserological examination using gel technologies makes it possible to diagnose rare forms of conflicts and to select a donor on an individual basis. Conclusion. Fetal MCA MBFV measurements permit fetal anemia to be predicted. The edematous form of fetal HD is a curable condition that calls for fetal emergency care: IUBT is an effective treatment for fetal HD. The gel method is optimal in performing an isoserological study.

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About the authors

A. V MAKAGON

Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences; City Clinical Hospital One

Email: makogon@ngs.ru
Novosibirsk

I. V ANDRYUSHINA

Novosibirsk State Medical University, Ministry of Health and Social Development of Russia

References

  1. Михайлов А.В. Внутриматочные вмешательства под ультразвуковым контролем во время беременности // Клиническое руководство по ультразвуковой диагностике / Под ред. В. В. Митькова, М. В. Медведева. — М.: Видар, 1996. - Т. 2. - С. 280-302.
  2. Сидельникова В.М., Антонов А.Г. Гемолитическая болезнь плода и новорожденного. - М.: Триада-Х, 2004.
  3. Эхография в акушерстве и гинекологии. Теория и практика / Под ред. А. Флейшера и др.: Пер с англ. - М.: Видар-М, 2004. - Ч. 2. - С. 115-151.
  4. Brass L.M., Pavlakis S.G., De Vivo D. Transcranial Doppler measurements of the middle cerebral arterkly. Effect of hematocrit // Stroke. - 1988. - Vol. 19. - P. 1466 - 1469.
  5. Diamond L.K., Blackfan K.D., Baty J.M. Erythroblastosis fetalis and its association with universal edema of the fetus, icterus gravis neonatorum and anemia of the newborn // J. Pediatr. - 1932. - Vol. 1. - P. 269-274
  6. Freda V.J., Gorman J.G., Pollack W. Successful prevention of experimental Rh sensitization in man with an anti-Rh gamma-2-globulin antibody preparation - A preliminary report // Transfusion. - 1964. - Vol. 4. - P. 26-31.
  7. Frigoletto F.D., Greene M.F., Benacerraf B.R. Ultramonographic fetal surveillance in the management of the isoimmunized pregnancy // N. Engl. J. Med. - 1986. - Vol. 315. -P. 430-432.
  8. Hudak M.L., Koehler R.C., Rosenberg A.A. et al. Effect of hematocrit on cerebral blood flow // Am. J. Physiol. - 1986. - Vol. 251. - P. 63-70.
  9. Levine P., Katzin E.M., Burnham L. Isoimmunization in pregnancy; its possible bearing on the etiology of Erythroblastosis fetalis // JAMA. - 1941. - Vol. 116. -P. 825-830.
  10. Liley A.W. Liquor amnii analysis and management of pregnancy complicated by rhesus immunization // Am. J. Obstet. Gynecol. - 1961. - Vol. 82. - P. 1359-1368.
  11. Mari G., Deter R.L., Carpenter R.L. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal redcell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses // N. Engl. J. Med. - 2000. - Vol. 342. - P. 9-14.
  12. Nicolaides K.H., Rodeck C.H., Mibashan R.S., Kemp J.R. Have Liley charts outlived their usefulness? // Am. J. Obstet. Gynecol. - 1986. - Vol. 155. - P. 90-94.
  13. Nicolaides K.H., Soothill P.W., Rodeck C.H., Clewell W Rh disease: intravascular fetal blood transfusion by cordocentesis // Fetal Ther. - 1986. - Vol. 1, № 4. - P. 185-192.
  14. Rizzo G., Capponi A., Rinaldo D. Release of vasoactive agents during cordocentesis: differences between normally grown and growth-restricted fetuses // Am. J. Obstet. Gynecol. - 1996. - Vol. 175. - P. 563-570.
  15. Rodeck C.H., Holman C.A., Karnieki J. Direct intravascular fetal blood transfusion by fetoscopy in severe rhesus isoimmunisation // Lancet. - 1981. - Vol. 1. - P. 652-654.
  16. Soothill P.W., Nicolaides K.H., Rodeck C.H. Relationship of fetal hemoglobin and oxygen content to lactate concentration in sensitized pregnancies // Obstet. Gynecol. - 1987. -Vol. 69. - P. 268-271.
  17. Vaughan J.I., Manning M., Warick R.M. Ihibition of erythroid progenitor cells by anti-Kell antibodies in fetal alloimmune anemia // N. Engl. J. Med. - 1998. - Vol. 338. - P. 798803.
  18. Vyas S., Nicolaides K.H., Campbell S. Doppler examination of the middle cerebral artery in anemic fetuses // Am. J. Obstet. Gynecol. - 1990. - Vol. 162. - P. 1066-1068.
  19. Weiner C.P. Fetal hemolytic disease. High risk pregnancy: management options / D.K. James, P.J. Steer, C.P. Weiner, B. Gonic. - 3rd ed. - Elsevier Saunders. Philadelphia, Pensylvania. - 2006. - P. 291-312.
  20. Weiner C.P., Williamson R.A., Wenstrom K.D. Management of fetal hemolytic disease by cordocentesis. Outcome of treatment // Am. J. Obstet. Gynecol. - 1991. - Vol. 165. -P. 1302-1307.
  21. Weiner C.P. Management of fetal hemolytic disease by cordocentesis: outcome of affected neonates not requiring transfusion // Fetal. Diagn. Ther. - 1996. - Vol. 176-178.

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