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4 results

  • Chapter 63 - Parvovirus B19 Infection in Pregnancy

  • from Section 11 - Infectious Conditions in Pregnancy
  • Edited by Amira El-Messidi, McGill University, Montréal, Alan D. Cameron, University of Glasgow
  • Book:
    OSCEs in Obstetrics and Maternal-Fetal Medicine
    Published online:
    23 February 2023
    Print publication:
    16 February 2023, pp 809-821

  • Summary

    You are on obstetrics call duty at a community hospital center, where a 30-year-old G2P1 elementary schoolteacher presents concerned, after receiving notification during this spring week holiday, that there is an outbreak of ‘slapped cheek syndrome’ among the children. The patient is at 16+3 weeks’ gestation by dating sonography performed by her primary care provider; first-trimester fetal morphology was normal with a low risk of aneuploidy. Three years ago, she had a healthy pregnancy and term vaginal delivery of her son, who currently attends daycare. The patient does not have any obstetric complaints.

  • Fetal Intra-Peritoneal Transfusion for the Management of Very Early Spontaneous Twin Anemia-Polycythemia Sequence in an Obese Patient With a Whole Anterior Placenta

  • Cécile Guenot, Romaine Robyr, Nicole Jastrow, Yvan Vial, Luigi Raio, David Baud
  • Journal:
    Twin Research and Human Genetics / Volume 19 / Issue 2 / April 2016
    Published online by Cambridge University Press:
    21 March 2016, pp. 154-157
    • Article
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  • Twin anemia-polycythemia sequence (TAPS) is a rare condition in monochorionic twin pregnancies. Small intertwin placental vascular communications allow transfusion, which results in a hemoglobin difference in the twins in the absence of oligohydramnios or polyhydramnios. We report here a case of TAPS diagnosed at 17 weeks’ gestation in an obese patient (BMI 42) with a whole anterior placenta. The only possible treatment at this stage of pregnancy was intra-uterine transfusion (IUT), which was repeated weekly until photocoagulation of placental anastomoses was feasible. Fetoscopic laser surgery is the only curative treatment, but is challenging in TAPS because of the absence of polyhydramnios and the presence of minuscule anastomoses. An anterior placenta and high BMI can make the procedure even more challenging. This case report demonstrates that very early and rapidly progressing TAPS with technically complicated conditions (elevated BMI and anterior placenta) can be successfully managed with IUT until laser procedure is achievable.

  • Section 1 - General principles

  • Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
  • Book:
    Fetal Therapy
    Published online:
    05 February 2013
    Print publication:
    13 December 2012, pp -

  • Summary

    Initial therapies such as intrauterine transfusion for severe hemolytic disease of the fetus were undertaken based on sound physiological principles and an understanding of the basic pathogenesis but were never subjected to randomized clinical trials. More recent targeted interventions for such conditions as treatment for severe twin-to-twin transfusion syndrome (TTTS), myelomeningocele (MMC) and congenital diaphragm hernia (CDH) have been the subject of well-designed randomized investigations. This chapter elucidates the history and the basis for the treatment of these fetal interventions. Routine induction of labor at a premature gestation was the only therapy that could be offered to attempt to curb the inevitable death due to hemolytic disease of the fetus and newborn (HDFN) that occurred in 30% of cases. The human fetus has indeed become a patient and development of treatments is a work in progress.

  • Section 2 - Fetal disease

  • Edited by Mark D. Kilby, Anthony Johnson, Baylor College of Medicine, Texas, Dick Oepkes
  • Book:
    Fetal Therapy
    Published online:
    05 February 2013
    Print publication:
    13 December 2012, pp -

  • Summary

    This chapter discusses the role of fetal therapy for fetal anemia, which has been one of the success stories of fetal medicine. There is a risk of red cell alloimmunization in any pregnancy where the mother is exposed to fetal red cells that possess antigens for which her own red cells are negative. A number of pregnancy-related events are associated with a risk of fetomaternal hemorrhage (FMH). A number of techniques have evolved over time to facilitate assessment of pregnancies at risk of 'hemolytic disease of the fetus and newborn' (HDFN). The aim of assessment is to identify the anemic fetus requiring intrauterine transfusion (IUT) before hydrops fetalis develops. However, monitoring an identified at-risk pregnancy to the point at which hydrops fetalis develops would be considered a management failure. Although less common than RhD disease, profound fetal anemia, hydrops, and intrauterine death can result from Kell alloimmunization.