Fetal Transfusion in Severe Rh Isoimmunization

Bowman, John M.

doi:10.1001/jama.1969.03150190023004

Cited by 21 publications

(3 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is not surprising that the AL between 27 and 33 weeks should almost coincide with the demarcation between Liley's top and middle prediction zones and also with the lower limits of the transfusion zones devised by Liggins (1966) and Robertson (1969). However, it is higher than the critical levels used for transfusion at some other centres (Gordon et al, 1966;Little et al, 1966;Bowman et al, 1969) which in our own cases would have led to some unnecessary fetal transfusions, including several in fetuses which did not even need exchange transfusion following delivery at term.…”

Section: Action Line Methodsmentioning

confidence: 67%

Rhesus haemolytic disease

Whitfield¹

1976

J Clin Pathol

View full text Add to dashboard Cite

Section: Action Line Methodsmentioning

confidence: 67%

Rhesus haemolytic disease

Whitfield¹

1976

J Clin Pathol

View full text Add to dashboard Cite

“…Transplacental digitalization of the fetus in cases of alloimmune anemia is generally used when there is hydrops. Although case reports have claimed successes [1,5], the efficacy of the treatment is not established as there are no controlled data. In the case of intravascular intrauterine transfusion, when there is rapid expansion of the fetoplacental blood volume, fetal heart failure may occur, even in the non-hydropic fetus.…”

Section: Discussionmentioning

confidence: 99%

“…In severe bloodgroup immunization this treatment may improve the outcome of pregnancy [1,2,5]. The rationale of this approach is based on the fact that digoxin crosses the placenta and if an adequate concentration is achieved, positive inotropic effect on the fetal heart will result.…”

Section: Introductionmentioning

confidence: 99%

Transplacental passage of digoxin in severe Rhesus immunization

Kanhai¹,

Il²,

Aj³

et al. 1990

Jpme

View full text Add to dashboard Cite

Maternal and umbilical vein digoxin concentrations were determined in 16 mothers and fetuses with severe Rhesus-D disease, eight with, and eight without prior digitalization of the mother, when umbilical cord puncture was performed for diagnosis and intrauterine blood transfusion. In the eight patients without digoxin treatment, the digoxin concentrations in both the mother and the umbilical vein were below the limit of detection (less than 0.3 nmol/l). In the other eight patients digitalization of the mother was started 24-48 hours before the first umbilical cord puncture. The maternal and umbilical vein digoxin concentrations were determined on 26 occasions. Except for two instances, digoxin concentrations in the umbilical vein were always below 1 nmol/l. The mean ratio of maternal to fetal digoxin concentrations before initial transfusion was 2.51 ( +/- ISD = 1.47) and before later transfusions 1.67 ( +/- ISD = 0.61). The differences in mean ratios between initial and later transfusions are not significant (p = 0.16). The mean ratio for the total group was 1.93 ( +/- ISD = 1.01). There was no correlation between the maternal to umbilical vein digoxin ratio and either gestational age or umbilical venous hematocrit. The results of our study indicate that the therapeutic effect of transplacental digitalization in severe Rhesus disease is questionable and that a multicentre randomized trial would be necessary to evaluate whether this treatment is of benefit.

show abstract