The impact of intrauterine transfusions on morphological picture of red cells in Rh incompatibility.

The purpose of the study was to analyse the changing picture of red cells in fetuses treated with intrauterine transfusions for Rh incompatibility. The study included 28 live-born infants who were given 48 intrauterine transfusions. The reference group consisted of 232 newborns with haemolytic disease of the newborn (HDN), untreated in the fetal period. The number of erythroblasts and reticulocytes in the red cells along with fetal haemoglobin (HbF), in relation to the number of the own erythrocytes of the fetus and the total number of red cells in cord blood were examined. The suppressing influence of the transfused blood on haematopoiesis and a significant stimulation of erythrocyte renowal, in cases of smaller number of HbF erythrocytes in cord blood were observed.

Treatment in Rh incompatibility.

In a material of 300 cases of Rh incompatibility the effectiveness of treatment was analyzed. An unfavourable effect of induction of premature labor was found in the cases with insufficient maturity of the newborn. A very high mortality of newborns with severe anemia (42.3%) was found. The results of treatment with intrauterine transfusions are described suggesting that they should be done before induction of labor in cases with probable high-grade anemia. The method of performing of the first exchange transfusion in the most severe cases is presented. The necessity of organization of therapeutic center of serological incompatibility all over the country is stressed.

The course of hemolytic disease of the newborn in Rh incompatibility.

In a material of 300 cases of Rh incompatibility the clinical course of the hemolytic disease of the newborn was analyzed together with the complications of this disease and perinatal mortality. It was found that the intensity of icterus and the number of necessary exchange transfusions depended mainly on the grade of anemia at the time of birth. Prematurity caused no worsening of neonatal icterus but increased the frequency of complications and mortality. The high mortality of children born with severe anemia points to the necessity of hemotherapy of the fetuses before labor.

Prognosis in Rh incompatibility.

The study was done on a material of 300 cases of Rh incompatibility. A relative correlation was found between fetal damage and newborn damage and the titer of antibodies. It was shown that production of anti-Rh antibodies was lower in feto-maternal ABO incompatibility. Coexistence of anti-Rh D antibody with other antibodies of the Rh system worsened the prognosis. Two prognostic tables are presented: one based on a comparison of antibody titers with history data, and the other which was a modification of Liley's method, containing additionally determination of antibodies, which increased the accuracy of prognosis. The best prognosis of fetal damage was obtained using the new pregnostic table and assessing the successive spectrophotometric investigations in the risk zone IIB.

Lymphocyte subpopulations in healthy newborns and in immunohemolytic anemia due to Rh incompatibility.

The subpopulations of lymphocytes in cord blood were analyzed in 50 healthy newborns and in 25 with hemolytic disease of the newborns (HDN) using E, EA, EAC rosette tests with sheep erythrocytes, EA rosette test with human erythrocytes and SmIg+ test. A statistically significant decrease of the percent of T lymphocyte and increase in the absolute values of all lymphocyte subpopulations were found in healthy newborns as compared with adults. In the newborns with HDN a correlation was observed between the severity of the disease and the results of rosette tests. Three groups were distinguished: 1) very low values of all rosette tests, severe anemia in newborns, and high titer of antibodies in their mothers, 2) low values of EA rosette tests, less severe anemia antibody titer in the mothers lower than in the first group, 3) rosette tests within normal range, newborns usually without anemia, low titer of maternal antibodies.

The effectiveness of intrauterine transfusions.

The results of treatment with intrauterine transfusion are presented. The analysis comprised 48 successful transfusions into 29 foetuses. The reference group consisted of 11 transfusions which proved nonfeasible or ineffective and 54 untreated cases. Following blood treatment, the newborn mortality rate dropped more than threefold. Long-term follow-up of 21 children generally showed their good physical and mental development. We also present 4 cases of supsequent pregnancies after intrauterine blood treatment in a preceding pregnancy, showing that it is possible to save the next baby of the same mother.

[Mortality of fetuses and newborns in gestosis EPH]. / Umieralnosc plodów i noworodków w gestozie eph.

The authors analysed perinatal mortality and the condition of 32 newborns of 30 pregnant women with a severe form of gestosis EPH, who did not react to therapy. In all the women the pregnancy was terminated prematurely between 29th and 37th week (not later than 7 days admission to hospital) because of threat to the fetus, threat to the pregnant woman due to renal failure or threat both to the fetus and the woman. In spite of the fact that the newborns had a lower birth weight in comparison with newborns born in the previous years, the above procedure led to the sixfold reduction of perinatal mortality. Fetal hypotrophia amounted to 43% and was ten times higher than in general population.