Emergent Fetal Intracardiac Transfusion for Thrombocytopenia and Acute Hypovolemia due to Cordocentesis-Associated Hemorrhage in Parvovirus-Induced Hydrops

Abstract

Objectives: To demonstrate the utility of fetal intracardiac transfusion to correct acute fetal hypovolemia and thrombocytopenia in fetal Parvovirus infection. Methods: Intracardiac transfusion in a 19-week gestation was indicated due to cordocentesis-associated hemorrhage. Results: Intracardiac transfusion resulted in correction of acute bradycardia, anemia and thrombocytopenia and persistent umbilical cord hemorrhage following attempted intravascular transfusion. Conclusions: This case illustrates the importance of anticipating both thrombocytopenia and anemia in fetal Parvovirus infection and how an intracardiac approach can be employed in the setting of acute, life-threatening hemorrhage.

Successful diagnostic and therapeutic intrauterine fetal interventions by natural orifice transluminal endoscopic surgery (with videos)

“…[15][16][17] In adults, the use of EUS plays a major role in the diagnosis and management of gastroenterologic and oncologic disorders. In addition to staging GI and pancreaticobiliary malignancies, EUS guidance has been used to perform various less-invasive but effective therapeutic interventions such as celiac nerve block and pancreatic pseudocyst drainage.…”

Fetal Cardiocentesis: A Review of Indications, Risks, Applications and Technique

“…Laboratory studies including complete blood count [13,14] , platelet count [21] , Kleihauer-Betke analysis (for documentation of a pure sample of fetal blood), metabolic profile, serologies for transplacental viral/protozoal infection, direct Coombs' assays and fetal blood gas analysis [22] may be reliably obtained and interpreted. Antsaklis et al [12] reported 158 cases of fetal cardiocentesis during the second trimester for the prenatal diagnosis of fetal hemoglobinopathy.…”

“…Though some data suggest that up to one-third of fetuses will experience spontaneous resolution [24] , intrauterine intravascular transfusion is felt to be the treatment of choice [25] , providing the best overall outcome. Sarno et al [21] reported successful reversal of hydrops due to fetal parvovirus infection in a 19-week gestation by a single intracardiac transfusion in a procedure complicated by hemorrhage from the initial attempt at cordocentesis.…”

“…Exchange of fetal blood for normal saline was effective in resuscitation of the fetus. Sarno et al [21] used intracardiac infusion of plasma, platelets and red cells to arrest cordocentesis-associated hemorrhage and correct fetal thrombocytopenia, bradycardia and hypovolemia in a case of parvovirus-induced hydrops. A healthy neonate was delivered at term.…”

Intracardiac Fetal Transfusion for Parvovirus‐Induced Hydrops Fetalis: A Salvage Procedure

“…These anatomic characteristics make the fetal right ventricle the most anterior cardiac chamber and the closest to the anterior chest wall, providing the shortest path to the fetal heart (Figure 2). 6 After insertion of a 22‐gauge needle into the amniotic cavity, the anterior chest wall should be approached perpendicularly. The right ventricle should be entered carefully through the apex of the heart, avoiding damage to the conduction system in the interventricular septum and the atrioventricular valves 7 .…”