[THE FETAL MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITY AS A PEDICTOR OF FETAL ANEMIA IN RH-ALLOIMMUNIZED PREGNANCY].

UNLABELLED: Rh-isoimmunization is a pathological condition in which the fetal red blood cells of a Rh (+) fetus are destroyed by the isoantibodies of a Rh (-) woman sensitized in a previous event. Despite of the wide spread implementation of anti D-gammaglobolin prophylaxis this is still the most common cause for fetal anemia. Recently, sonographic measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) has been shown to be an accurate non-invasive test to predict low fetal hemoglobin levels. We present a case report of Rh-alloimmunized pregnancy with moderate fetal anemia, followed-up by weekly MCA-PSV measurements. CASE REPORT: A 37-year-old Rh (-) negative gravida 3, para 1, without anti-D gammaglobolin prophylaxis in her previous pregnancies, presented at 27+0 weeks of gestation (w.g.) for a routine third trimester scan. Subsequent ultrasound measurements of MCA-PSV confirmed a progressive increase of the peak systolic velocities from 40 to 80 cm/sec, as well as a gradual rise in the anti-D titers. The evidence of developing fetal anemia necessitated elective Caesarean section performed at 35 wg. The neonate was admitted in the intensive care unit and required resuscitation, one exchange blood transfusion and several courses of phototherapy. The patient was discharged two weeks post partum. CONCLUSIONS: There is a strong correlation between the high peak systolic velocities in the middle cerebral artery (MCA-PSV) and the low levels of fetal hemoglobin. The high sensitivity and positive predictive value concerning the development of fetal anemia, as well as its good repeatability, makes this non-invasive test a valuable asset in the management of all pregnancies complicated by severe Rh-alloimmunization.

[Treatment of preterm delivery with calcium channel blockers--Nifedipine].

AIM: To assess the feasibility of the calcium antagonist Nifedipine as an oral tocolytic for the treatment of preterm labor. METHODS: Thirty-seven pregnant women in preterm labor participated in a prospective longitudinal study. Inclusion criteria were: gestational age between 24 and 32 weeks gestation; uterine contractions in 30 min interval; lack of cervical dilatation and lack of contraindications for tocolysis. In all cases the calcium antagonist Nifedipine was used in dosage 4 x 10 mg per os. The clinical response to tocolysis, gestational age at delivery and potential side effects were analyzed. RESULTS: Forty-one pregnant women participated in the study. Two were lost for follow up and another two cases were excluded because myoma uteri was diagnosed. Thirty-seven pregnancies were finally analyzed. In five of them maternal contractions persisted despite of treatment which necessitated parenteral tocolysis. In two of these five cases the pregnancy was terminated (1--spontalneous abortion in 26 w.g., 1--preterm delivery at 32 w.g.). The other 32 pregnancies were delivered at term without any side effects attributed the treatment. CONCLUSION: Nifedipine is an effective oral tocolytic and a rational alternative to other tocolytic agents in the management of preterm labour.