Transplacental passage of digoxin in severe Rhesus immunization

Abstract

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.

Rhesus disease: postnatal management and outcome

“…Normalization of the haemoglobin level should be achieved by a partial exchange transfusion rather than a simple transfusion, as patients with Rh disease and hydrops fetalis have normal blood volumes [41] and may have elevated central venous pressure [42]. Dexamethasone or betamethasone should have been given to the mother if preterm delivery is anticipated, but the bene®t of other therapies [22,41] has not been rigorously tested.…”

Maternale und fetale Digoxinspiegel bei fetofetalem Transfusionssyndrom (FFTS)*

“…Der maternofetale Gradient als Quotient aus fetalem und maternalem Serumspiegel zeigt im hier beschriebenen Studienkollektiv eine deutliche Abhängigkeit vom Geburtsgewicht und somit vom Schwangerschaftsalter. Andere Studien ergaben Gradienten von 0,19 bis 0,86 [10,11,12,13], wobei insbesondere bei sehr unreifen Kindern mit Zeichen der fetalen Herzinsuffizienz ein besonders schlechter transplazentarer Digoxintransfer be- Abb.1 Regressionsanalyse mütterlicher und fetaler Digoxinspiegel.…”