A prospective observational study at the newly estab-lished Fetal Medicine Unit, Hamad Hospital, Qatar; evalu-ated the impact of the service on the detection rate of criti-cal congenital heart defects, patterns of referral and sub-sequent yield for structural congenital heart disease in a population with a significant proportion of high risk fac-tors. Of 391 pregnant females examined between January 2003 and December 2004, 58 (14.8%) had fetal cardiac abnormalities of which 23 (5.8% of total referrals) had major structural malformations of the heart. Cases of fetal congenital heart disease had further evaluation us-ing real time three-dimensional echocardiography (RT3DE) which is new equipment in the paediatric cardi-ology department. All cases with cardiac defects whether minor or major had follow up fetal echocardiography. Neonatal echocardiography confirmed the diagnosis in all cases with major defects (100% specificity). False positive cases that were found to be normal post natal were 1% of the total cases referred (12% of cases with congenital mal-formation). False negative cases were 1% and all had a small ventricular septal defect (VSD) except for one Down's syndrome with a very large VSD. Three patients needed urgent Caesarean section (CS) deliveries, one with complete heart block (HB) and two with supraventricular tachycardia (SVT). One patient traveled abroad as the fetus had left isomerism and major cardiac defects and complete HB. Fifteen newborns had to receive prostaglandin based on the fetal diagnosis before being seen by paediatric cardiologists. There was no termination of pregnancy due to major cardiac defects even in cases of HLHS. The preliminary results of this clinic are very satisfac-tory and have affected favorably the outcome of the new-borns with congenital heart defects. It is hoped that the results of this study will encourage more referrals to the FMU.
The number of pregnancies following organ transplantation is increasing due to better patient and graft survival We describe the pregnancy course, complications and outcome in patient with liver transplant and spleenovenal shunt for the first time in the history of the Women's Hospital in Doha, Qatar. Following successful liver transplantation, menstrual cycle returns to normal in a few months and pregnancy may be ensued{ l). We report the management and outcome of the pregnancy of a 22-year old female with orthotopic liver transplant and spleenovenal shunt with regard to safety to the mother; the fetus and transplanted graft. The pregnancy was terminated at 29 weeks of gestation by caesarean section because of severe Pre-eclampsia and fetal distress. Both mother and baby did well.
Familial haemolytic uraemic syndrome (HUS) frequently leads to end stage kidney disease and often recurs after transplantation. Long term graft survival after recurrence of is very poor, with almost all grafts being lost over a period of time. We present the case of a 20 year old girl who developed recurrent HUS in infancy and progressed to end stage kidney at the age of 11. An older sibling had died of HUS in the fi rst year of life. She has no known mutations in the Factor H, Factor I or MCP genes and further mutation analysis for complement defects is underway. She received a well matched deceased donor kidney at the age of 18. Her initial immunosuppression regimen consisted of basiliximab, methylprednisolone and mycophenolate mofetil. The introduction of tacrolimus was delayed until day 5 when her renal function had stabilised. She received fresh frozen plasma (FFP) pre operatively, then daily for one week post transplant, twice weekly for a further fortnight and then weekly as part of a recurrence prevention plan. She had immediate graft function and the fi rst post operative month was uneventful. On day 49, she had a sharp rise in serum creatinine to 150 mol/L (baseline 80-90 mol/L). This was associated with a rise in LDH, although haemoglobin and platelet counts remained stable. She was commenced on high dose FFP infusions (30ml/kg/day) for 4 days. Transplant biopsy confi rmed early HUS recurrence and she began plasmapheresis with FFP on day 54. She received daily plasmapheresis sessions for one week, then 2-3 weekly sessions for a further 3 weeks, then weekly sessions for a further 5 weeks. Following discontinuation of plasmapheresis she received daily high dose FFP for a week and the frequency of these infusions was weaned and fi nally stopped 6 months post transplant. At present she has excellent allograft function with a serum creatinine of 80 mol/L and has shown no further signs of disease recurrence. A high level of suspicion should be maintained for recurrent HUS post transplantation even in the absence of typical features of thrombotic microangiopathy. Early diagnosis and prompt treatment with high dose FFP infusions, a prolonged course of plasmapheresis and slow tapering of the FFP infusions may have been benefi cial in retaining allograft function in our patient. Introduction: Accurate and reliable measurement of anti-A and anti-B antibody titre is important in the management of patients undergoing or being considered for ABO-incompatible organ transplantation. Development of new protocols on the basis of clinical experience is important in improving outcomes. However due to lack of a standardized method for measuring antibody titres, results from different centres are not comparable. The purpose of this study was to develop a simple, reliable and sensitive method for measuring anti-A and anti-B antibody titre. Methods: Serum samples from human volunteers of different ABO-blood types (n=20) were tested for anti-A and anti-B titre by our newly developed microplate assay and the widely used tube te...
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