Intravascular neuromuscular blockade for fetal transfusion

Byers, James; Aubry, Richard H.; Feinstein, Steven J.; Lodeiro, Jorge G.; McLaren, Rodney; Srinivasan, J; Sunderji, Shiraz

doi:10.1016/0002-9378(88)90052-x

Cited by 2 publications

(2 citation statements)

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“…In these circumstances, cord haematoma may develop if needle displacement occurs (as in cases 1 and 2). To prevent this possible hazard, several authors have suggested immobilizing the fetus by injecting pancuronium bromide or d-tubocurare into the fetal circulation (Byers, 1988;Copel, 1988;Moise, 1987;Pielet, 1988;Robinson et al, 1985). The intrainuscular administration of these muscle relaxants entails a slow absorption rate and raises the risk of fetal injuries.…”

Section: Discussionmentioning

confidence: 99%

“…:intrauterine blood transfusion represents the only modality for salvaging pregnancies with severe blood cell isoimmunization. Today, ultrasound-guided fetal blood i ransfusion is the method of choice (Bang et al, 1982;Berkowitz et al, 1986;Byers, 1988;Copel, 1988;de Crespigney, 1985;Grannum, 1986;Hansmanri et al, 1986;Jaquetin et al, 1986;Moise, 1987;Nicolaides et al, 1986;Nicolini et al, 1988;Pielet vt al., 1988), being easier, less invasive, and associated with a lower complication rate than the fetoscopic technique (Rodeck et al, 1981(Rodeck et al, , 1984. However, a number of technical problems and possible complications have recently come to light ( Ber'kowitz, 1987;Jauniaux et al, 1989;Nicolini et al, 1988;Pielet et al, 1988).…”

Section: Introductionmentioning

confidence: 99%

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Umbilical cord haematoma as a complication of intrauterine intravascular blood transfusion

et al. 1990

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Between October 1985 and February 1989, 49 ultrasound-guided intravascular fetal blood transfusions were performed in 16 patients (14 with rhesus (Rh) isoimmunization, 2 with non-immunologic hydrops fetalis (NIHF)). As an intra-operative complication, perivascular haematoma of the cord occurred in three patients (7 per cent). In two cases, fetal bradycardia necessitated delivery by Caesarean section at 30 and 32 weeks' gestation, respectively. In the third case, fetal bradycardia developed during transfusion, at 31 weeks' gestation, but normalized within 3 min. The baby was delivered as planned at 36 weeks of gestation, after another transfusion at 34 weeks. Dislodgement of the needle tip into perivascular tissue, caused by sudden fetal or maternal movements, is the reason for this complication. The haematoma develops as a result of delayed recognition and continuous transfusion into Wharton's jelly. Cord haematoma may be diagnosed in time by continuous ultrasound imaging, as illustrated in case 3. To minimize the risk of needle dislodgement during transfusion, sedation of the mother and complete immobilization of the fetus by injecting a short-acting muscle relaxant into the umbilical vessel are recommended.

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Section: Discussionmentioning

confidence: 99%