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Pesquisa : C16.614.053.511 [Categoria DeCS]
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  1 / 1158 MEDLINE  
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PMID:29341561
Autor:Dobrosavljevic A; Martic J; Rakic S; Pazin V; Jankovic-Raznatovic S; Sreckovic S; Dobrosavljevic B
Título:Massive fetomaternal hemorrhage as a cause of severe fetal anemia.
Fonte:Vojnosanit Pregl; 73(11):1068-71, 2016 Nov.
ISSN:0042-8450
País de publicação:Serbia
Idioma:eng
Resumo:Introduction: Fetomaternal hemorrhage (FMH) is a transfu-sion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest vol-umes of 80 mL and 150 mL as a threshold which defines mas-sive FMH. Therefore, a rate of massive FMH is 1 : 1,000 and 1 : 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifesta-tions of FMH are nonspecific, and mostly it presented as re-duced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report: A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gesta-tion. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Im-mediately after admission, the women delivered vaginally. Ap-gar scores were 1 and 2 at the first and fifth minute, respec-tively. Immediately baby was intubated and mechanical ventila-tion started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normaliza-tion of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion: For the successful diagnosis and management of FMH direct commu-nication between the obstetrician and the pediatrician is neces-sary as presented in this report.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (AFP protein, human); 0 (Biomarkers); 0 (alpha-Fetoproteins); 9034-63-3 (Fetal Hemoglobin)


  2 / 1158 MEDLINE  
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PMID:28295352
Autor:Ghesquière L; Houfflin-Debarge V; Behal H; Coulon C; Subtil D; Vaast P; Garabedian C
Endereço:Jeanne de Flandre Hospital, Lille University Hospital CHRU.
Título:Should optimal timing between two intrauterine transfusions be based on estimated daily decrease of hemoglobin or on measurement of fetal middle cerebral artery peak systolic velocity?
Fonte:Transfusion; 57(4):899-904, 2017 Apr.
ISSN:1537-2995
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: To best predict the recurrence of fetal anemia after intrauterine transfusion (IUT), the measurement of middle cerebral artery peak systolic velocity (PSV) and the estimation of hemoglobin (Hb) daily decrease are compared. STUDY DESIGN AND METHODS: A retrospective study including 38 patients who had at least two IUTs in a context of red blood cell alloimmunization was conducted. PSV values before first, second, and third IUTs were collected and expected Hb level was calculated according to various Hb daily decrease formulas as proposed in the literature. RESULTS: Comparison of PSV receiver operating characteristic curves with the various Hb levels did not find any significant difference between first and second IUTs. On the other hand, we found a significant difference between the second and third IUTs, with better prediction of fetal anemia through Hb decrease calculation, whatever the formula. Between the second and third IUTs, no formula was significantly better than the others. CONCLUSION: The timing of a second transfusion can be difficult to determine with certainty, but PSV can give an accurate assessment of when to resample the fetus with probably a higher recommended threshold for the diagnosis of fetal anemia. Subsequent to a second transfusion, the intertransfusion interval should be based on estimated Hb decrease rather than PSV thresholds, whatever the chosen formula proposed in the literature. Larger numbers are needed to definitely make this recommendation and it will be interesting to evaluate correlation between different antibodies.
Tipo de publicação: CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE


  3 / 1158 MEDLINE  
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PMID:28238383
Autor:Ravishankar S; Migliori A; Struminsky J; Has P; Sung CJ; He M
Endereço:Women & Infants Hospital of Rhode Island, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States.
Título:Placental findings in feto-maternal hemorrhage in livebirth and stillbirth.
Fonte:Pathol Res Pract; 213(4):301-304, 2017 Apr.
ISSN:1618-0631
País de publicação:Germany
Idioma:eng
Resumo:Feto-maternal hemorrhage (FMH) is not an uncommon event during pregnancy with important clinical implications for both maternal and fetal outcomes. The diagnosis is often made using Kleihauer-Betke (KB) test. As FMH occurs transplacentally, examination of the placenta may contribute to the diagnosis of FMH. This retrospective case-control study aims to examine the placental features associated FMH in patients with known positive KB test results. When compared with KB negative placentas (n=88), KB positive placentas (n=49) had significantly higher incidence of pallor (6/49 vs 0/88, p=0.0017), IVT (11/49 vs. 5/88, p=0.0032) and nRBCs (12/49 vs. 4/88, p=0.0008). Autopsy cases with fetal or neonatal death due to FMH, (n=13) compared to a cohort of 162 placentas associated with other, non-FMH causes of death also had significantly higher frequency of pallor (5/13 vs 0/162, p<0.0001), IVT (6/13 vs 24/162, p=0.011) and nRBCs (11/13 vs 67/162, p=0.003). Pallor and nRBC were also associated with higher volume of FMH. Placental parenchymal pallor, intervillous thrombi and presence of nRBCs are significantly associated with documented FMH in both normal pregnancies and pregnancies associated with fetal or neonatal death. The presence of these findings, especially in combination, may suggest the need for maternal KB testing to rule out FMH and neonatal monitoring and/or intervention.
Tipo de publicação: JOURNAL ARTICLE


  4 / 1158 MEDLINE  
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PMID:28168818
Autor:Ishiguro T; Suda K; Enomoto T
Endereço:Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Título:Biochemical analysis of intraplacental choriocarcinoma and fetomaternal transfusion.
Fonte:J Obstet Gynaecol Res; 43(3):587-591, 2017 Mar.
ISSN:1447-0756
País de publicação:Australia
Idioma:eng
Resumo:Intraplacental choriocarcinoma is one of the rarest forms of gestational tumors and is believed to be one of the causes of fetomaternal transfusion (FMT). A 35-year-old woman, gravida 2, para 2, with a history of two vaginal deliveries, was incidentally diagnosed as having stage I gestational intraplacental choriocarcinoma with a FIGO/World Health Organization 2000 risk score of 2 after term delivery. This disease caused neonatal anemia but did not metastasize to either the mother or infant. Short tandem repeat analysis with laser microdissection revealed that the tumor had originated from the current pregnancy. Serological test and immunohistochemical analysis revealed that the patient and her baby suffered from FMT. She has been free from disease without any medical intervention for the last 1 year. A combination of multiple biochemical analyses might help us diagnose the precursor pregnancy of a gestational choriocarcinoma and FMT.
Tipo de publicação: CASE REPORTS


  5 / 1158 MEDLINE  
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PMID:28164304
Autor:Delaney M; Wikman A; van de Watering L; Schonewille H; Verdoes JP; Emery SP; Murphy MF; Staves J; Flach S; Arnold DM; Kaufman RM; Ziman A; Harm SK; Fung M; Eppes CS; Dunbar NM; Buser A; Meyer E; Savoia H; Abeysinghe P; Heddle N; Tinmouth A; Traore AN; Yazer MH; BEST Collaborative
Endereço:Bloodworks Northwest & Department of Laboratory Medicine & Pediatrics, University of Washington, Seattle, Washington.
Título:Blood Group Antigen Matching Influence on Gestational Outcomes (AMIGO) study.
Fonte:Transfusion; 57(3):525-532, 2017 Mar.
ISSN:1537-2995
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Red blood cell (RBC) antigen matching policies to prevent alloimmunization in females of childbearing potential (FCP) vary between centers. To inform transfusion centers responsible for making decisions about matching policies for FCPs, the causal stimulus of the antibodies implicated in severe hemolytic disease of the fetus and newborn (HDFN) must be determined. STUDY DESIGN AND METHODS: We conducted a multinational retrospective study of women with offspring affected by severe HDFN requiring neonatal exchange transfusion and/or intrauterine transfusion. Mothers treated at centers that provide extended antigen-negative RBCs (MATCH, five centers) and those that do not (NoMATCH, nine centers) were compared. RESULTS: A total of 293 mothers had at least one affected pregnancy: 179 at MATCH centers and 114 at NoMATCH centers. Most alloimmunization (83%) was attributed to previous pregnancy: 3% to transfusion (two cases at MATCH, six at NoMATCH centers) and 14% undetermined (both antecedent transfusion and pregnancy). Only 50 mothers had received transfusions; 13 had HDFN due to anti-K at MATCH and four at NoMATCH centers. Most (12/13, 92%) of the anti-K HDFN cases at MATCH centers had K+ paternal antigen status. Mothers at the MATCH centers do not appear to be protected from HDFN due to K, C, c, and E antibodies, although the low number of FCPs who received transfusions precluded drawing firm conclusions. CONCLUSION: The causal stimulus of antibodies that cause HDFN is predominantly from previous pregnancy. Although extended RBC matching for FCPs may impart some protection from allosensitization, we were unable to show a positive effect, possibly because matching policies are not uniform and there was a small number of mothers who previously received transfusions.
Tipo de publicação: CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
Nome de substância:0 (Blood Group Antigens); 0 (Isoantibodies)


  6 / 1158 MEDLINE  
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PMID:27960562
Autor:Cozzolino M; Magro Malosso ER; Perelli F; Franchi C; Coccia ME
Endereço:a Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynaecology , University of Florence, Careggi University Hospital , Florence , Italy.
Título:Keep in mind foetomaternal haemorrage in case of reduced foetal movements: a successful obstetric management.
Fonte:J Obstet Gynaecol; 37(1):100-102, 2017 Jan.
ISSN:1364-6893
País de publicação:England
Idioma:eng
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  7 / 1158 MEDLINE  
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PMID:27862486
Autor:Refsum E; Mörtberg A; Dahl J; Meinke S; Auvinen MK; Westgren M; Reilly M; Höglund P; Wikman A
Endereço:Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Título:Characterisation of maternal human leukocyte antigen class I antibodies in suspected foetal and neonatal alloimmune thrombocytopenia.
Fonte:Transfus Med; 27(1):43-51, 2017 Feb.
ISSN:1365-3148
País de publicação:England
Idioma:eng
Resumo:OBJECTIVES: To investigate the specificities and level of HLA class I antibodies in selected cases referred for suspected foetal and neonatal alloimmune thrombocytopenia (FNAIT). BACKGROUND: FNAIT occurs in 1 : 1-2000 live births, whereas maternal immunisation against human leukocyte antigen (HLA) class I is common. Whether HLA class I antibodies alone can cause FNAIT is debatable. MATERIAL AND METHODS: A total of 260 patient samples were referred between 2007 and 2012. Referrals with maternal HLA class I antibodies and no other cause for the neonatal thrombocytopenia were included for analysis (cases, n = 23). HPA-1a negative mothers were excluded. Control groups were screened positive mothers of healthy neonates (controls, n = 33) and female blood donors (blood donors, n = 19). LABScreen single antigen HLA class I beads was used for antibody analysis. Clinical records were reviewed for cases. RESULTS: All groups had broad antibody reactivity. Cases had more antibodies with high SFI levels compared with the controls (SFI>9999; medians 26, 6 and 0; P < 0·05) and higher overall median HLA-ABC and HLA-B SFI (P < 0·05). Many of the antibodies were reactive with rare alleles. When reviewing the clinical records, several of the cases had other contributing factors to the thrombocytopenia. There was no correlation between foetal platelet count and antibody levels. CONCLUSION: Mothers of thrombocytopenic neonates had higher levels of HLA class I antibodies compared with control groups of women with healthy children and female blood donors. However, clinical outcome and antibody response correlated poorly in the heterogeneous case group, indicating a multifactorial cause to the thrombocytopenia in the majority of cases.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Autoantibodies); 0 (Histocompatibility Antigens Class I)


  8 / 1158 MEDLINE  
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PMID:27174184
Autor:Bellussi F; Perolo A; Ghi T; Youssef A; Pilu G; Simonazzi G
Endereço:Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Título:Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review.
Fonte:Fetal Diagn Ther; 41(1):1-7, 2017.
ISSN:1421-9964
País de publicação:Switzerland
Idioma:eng
Resumo:OBJECTIVES: To analyze the role of middle cerebral artery (MCA) peak systolic velocity (PSV) in the prediction of severe fetomaternal hemorrhage (FMH) and to compare it with standard biophysical assessment. DATA SOURCES: Retrospective review of cases of FMH seen in our unit and systematic review of the literature. RESULTS: We followed the MOOSE guidelines to review the literature. From 838 articles, 16 were selected. In total, 35 women, including 3 cases from our center and 32 obtained from the literature search were included. Diagnosis of FMH was always confirmed by laboratory tests. Patients were seen at 31 ± 5 weeks' gestation (range 16-39) and the most frequent indication for referral was decreased perception of fetal movements. Cardiotocography (CTG) upon admission was sinusoidal in 18 cases, nonreactive in 6, decelerative in 2 and tachycardic in one. MCA-PSV was abnormal in all cases but one. There were 2 perinatal deaths. The mean hemoglobin concentration at birth or at intrauterine transfusion was 4.8 ± 1.9 g/dl. DISCUSSION: The most accurate predictor of FMH was fetal MCA-PSV. CTG was always abnormal but the pattern was frequently nonspecific. We suggest including fetal cerebral Doppler in the evaluation of patients with decreased fetal movements, particularly in those cases with ambiguous results of biophysical testing.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE; REVIEW


  9 / 1158 MEDLINE  
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PMID:28040153
Autor:Cozzolino M
Endereço:Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy. Electronic address: maurocoz@yahoo.it.
Título:Fetomaternal hemorrhage in case of reduced fetal movements: The rules of computerized cardiotocography and middle cerebral artery.
Fonte:Taiwan J Obstet Gynecol; 55(6):916-917, 2016 12.
ISSN:1875-6263
País de publicação:China (Republic : 1949- )
Idioma:eng
Tipo de publicação: LETTER; COMMENT


  10 / 1158 MEDLINE  
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PMID:28040144
Autor:Teraoka Y; Samura O; Mukai Y; Sasaki M
Endereço:Department of Obstetrics and Gynecology, Onomichi General Hospital, Hiroshima, Japan. Electronic address: yteraoka@hiroshima-u.ac.jp.
Título:A case of fetomaternal transfusion in trichorionic triamniotic triplets.
Fonte:Taiwan J Obstet Gynecol; 55(6):895-896, 2016 Dec.
ISSN:1875-6263
País de publicação:China (Republic : 1949- )
Idioma:eng
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância:0 (Tocolytic Agents); I0Q6O6740J (Ritodrine)



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