Controlled fine needle biopsy of the uterine cervix during pregnancy.

OBJECTIVE: Cervical sampling could furnish tissue-based information regarding premature cervical ripening and effacement. This report assesses the effect of cervical fine needle biopsy (FNB) in the evaluation of cervical shortening. METHODS: Retrospective cohort study evaluating adverse events during the first week following FNB in women with short cervix. Patients with a cervical length(CL) ≤25 mm had a cervical FNB between 16 and 24 weeks. The risk of FNB was compared to a control group that was similarly evaluated but did not undergo FNB. RESULTS: One hundred and thirty-two FNBs were performed in 94 participants. The mean gestational age and CL at enrollment were 20.4 ± 2.3 weeks and 15.7 ± 0.6 mm. Within 7 days of FNB, there were 3 adverse events (2.3%) in the study group compared to 5 in the control group (2.1%). CONCLUSIONS: FNB of the cervix in high risk gravidae is feasible in clinical situations. It did not increase the risk of adverse events compared to women studied under a similar protocol without FNB.

Combined plasmapheresis and intravenous immune globulin for the treatment of severe maternal red cell alloimmunization.

OBJECTIVE: The objective of the study was to report the maternal and perinatal outcome in patients with severe red cell alloimmunization in pregnancy who were treated with immunomodulation therapy. STUDY DESIGN: This was a retrospective multicenter case series. Patients with a history of early second-trimester fetal loss secondary to severe maternal red cell alloimmunization or patients with markedly elevated maternal antired cell titers felt to be consistent with poor fetal outcome were offered treatment. Therapy consisted of serial plasmapheresis followed by weekly infusions of intravenous immune globulin (IVIG). Maternal titers were measured before and after plasmapheresis. RESULTS: Pregnant patients with either a history of a previous perinatal loss (n = 7) or markedly elevated maternal antibody titers (n = 2) were treated with combined plasmapheresis and IVIG. All 9 fetuses subsequently required intrauterine transfusions (median 4; range 3-8). All infants survived with a mean gestational age at delivery of 34 weeks (range 26-38 weeks). Maternal antired cell titers were significantly reduced after plasmapheresis (P < .01) and remained decreased during IVIG therapy. Serial peak middle cerebral artery velocities remained below the threshold for moderate to severe fetal anemia during therapy. CONCLUSION: Combined immunomodulation with plasmapheresis and IVIG represents a successful approach to the treatment of severe maternal red cell alloimmunization.