Transfusión intrauterina. Nuestra experiencia en el Hospital Universitario Materno Infantil de Canarias / Intrauterine transfusion. Experience in Canaries University Hospital Maternity Ward

Objetivo. evaluar los casos de transfusión intravascular intrauterina por anemia fetal realizados en la Unidad de Medicina Fetal del Hospital Universitario Materno Infantil de Canarias. Material y método. estudio descriptivo y prospectivo de los casos diagnosticados de anemia fetal y a los que posteriormente se sometió a transfusión intravascular intrauterina en el período comprendido entre mayo de 2007 y junio de 2009. Resultados. durante ese período se diagnosticaron 7 casos de anemia fetal: 4 de anemia fetal inmune y 3 no inmune. En 2 casos los padres no autorizaron la transfusión. Se realizaron un total de 8 transfusiones intravasculares a los 5 casos restantes, y a 2 de éstos se realizaron transfusiones de forma repetida. Conclusiones. la transfusión intravascular es el método de elección para el tratamiento de la anemia fetal en nuestro medio. Tras iniciarse en el año 2007 el uso de este tratamiento, se ha podido realizar en todos los casos en que se encontraba indicado(AU)

Objectives. to present intrauterine intravascular transfusions cases performed for fetal anaemia in Fetal Medicine Unit of Canaries University Hospital Maternity Ward. Material and method. prospective descriptive study of cases diagnosed of fetal anaemia that were treated with intrauterine transfusion from may 2007 to June 2009. Results. during this period seven cases of fetal anaemia were diagnosed. Four isoimmunization-anaemia and three of non-immune anaemia. Eight intrauterine transfusions were performed in five of cases (in two cases repeated transfusion was required). Two cases did not allow transfusion. Conclusion. blood transfusion through umbilical cord seems to be the best option for fetal anaemia treatment. After first intrauterine transfusion in 2007, all indicated cases were carried out(AU)

Safer cordocentesis by new 25-gauge needles.

OBJECTIVE: The objective of this study was to establish safer cordocentesis by using newly produced 25-gauge needles rather than the needles currently used. METHODS: Human umbilical cords were preserved in experiment 1. Pinching both ends, cordocenteses were performed by filling the cord with saline inside the sphere of the pressure-equilibrated Ringer's solution bag in an aquarium. Pressure alterations were recorded before and after the cordocenteses (n = 5 in each needle) using 22-, 23-, and 25-gauge needles. In experiment 2, human umbilical blood after delivery was preserved. Umbilical blood was drawn in syringes, and fixed in syringe infusion pumps of 150 ml/h. The blood (n = 8) was then pushed into the test tubes through 22-, 23-, and 25-gauge needles. Hemolysis and platelet activation were evaluated. As in the case of clinical data, non-stress tests (NST) subsequent to cordocenteses were compared between 23-gauge (n = 19) and 25-gauge (n = 16) needles. RESULTS: In experiment 1, the 25-gauge cordocenteses documented a more favorable pressure curve than other needles. In experiment 2, no statistical significance was observed for plasma-free hemoglobin, total bilirubin, hemoglobin, AST, LDH, potassium, platelet count, beta-thromboglobulin, and platelet factor IV. As in the case of clinical data, NSTs subsequent to cordocenteses revealed strong significance in the duration to recover variability (p = 0.0003) and the duration to recover acceleration (p = 0.0033). CONCLUSION: We concluded that 25-gauge needles appear superior in avoiding blood loss in the leaking phase. Although blood drawing takes time in the sampling phase, no hemolysis or platelet activation was observed. NST proved that 25-gauge cordocenteses showed favorable patterns. We propose that use of 25-gauge needles is promising under appropriate procedures in cordocentesis.

[The use of the "APT test" in estimating fetal hemoglobin in genetic cordocentesis]. / Wykorzystanie testu APT do oceny hemoglobiny plodowej w kordocentezie genetycznej.

OBJECTIVES: To determine whether it is fetal blood and not with mother blood in question. DESIGN: We discuss the "Apt test" results which examines the fetal hemoglobin in blood samples obtained by genetic cordocentesis. This material was used to elaborate the fetal cariotypes. MATERIALS AND METHODS: 106 samples of blood samples obtained by genetic cordocentesis were examined. Examination of each cordocentesis blood sample intended for genetic tests by means of a test estimating fetal hemoglobin (HbF). In each case the estimation was independently done by means of the Kleihauer-Betke method. RESULTS: The obtained results have evidenced the full usefulness of the "APT test" in genetic cordocentesis. CONCLUSIONS: The ATP test allows to estimate the HbF in the analysed sample of fetal blood in a course of few seconds.

Teaching ultrasound-guided invasive procedures in fetal medicine: learning curves with and without an electronic guidance system.

OBJECTIVE: To compare the learning curves of inexperienced junior obstetrics/gynecology registrars for ultrasound-guided invasive procedures on a training model, with and without an electronic guidance system. STUDY DESIGN: Four junior registrars performed their first 100 procedures on a training model with a new electronic guidance system, and four other junior registrars performed their first 100 procedures on the same training model without using the guidance system. All procedures were performed using a free-hand technique. We evaluated the quality of the procedure, which we defined as the time spent with the entire needle clearly visualized on the screen over the total duration of the procedure. We constructed learning curves for the eight junior registrars for comparative analysis. RESULTS: Quality of the procedure increased over time for all trainees. The learning curves were significantly steeper for trainees using the electronic guidance system. Trainees using the electronic guidance system performed better in the middle of their learning curve (procedures 25-75). All trainees reached the same level of quality by the end of their 100 procedures. CONCLUSIONS: The automated electronic guidance system helps faster learning but, after 100 procedures on a training model, both groups reached the same level of quality.