Five hundred cordocenteses were performed between 12 and 21 weeks. The indications were thalassaemia (386), rapid karyotyping (97), feto-maternal allo-immunization (10), rubella (6), and toxoplasmosis (1). One hundred and ten pregnancies underwent termination on the basis of the result, while 20 of the 370 pregnancies intended to continue were lost to follow-up. Amongst these were 16 fetal losses (4.3 per cent) and 22 premature deliveries (5.9 per cent); no other complications were reported. Four adverse prognostic factors were identified: (a) cord bleeding; (b) fetal bradycardia; (c) prolonged procedure time; and (d) anterior insertion of the placenta. There was no 'obvious' difference in fetal loss rate with advancing gestation until 19-21 weeks, when the risk of fetal loss decreased to 2.5 per cent.

Celocentesis can be a reliable procedure for earlier prenatal diagnosis of fetal monogenic diseases.

Summary:The use of hematopoietic stem cells for in utero transplantation to create permanent hematochimerism represents a new concept in fetal therapy, although this approach has provided heterogeneous results. In this paper we have undertaken molecular, phenotypic and functional studies aimed at identifying the presence of fully competent T lymphocytes in samples of fetal livers and cord blood. We found mature VDJ TCR ␤ chain transcripts in fetal liver cells taken from 7 to 16 weeks of gestation and a similar pattern was detected in cord blood cells sampled from 13.5 to 20.5 weeks of gestation. A V␤8 gene sequence comparable to that detected in adult PBMC was found in fetal liver samples at 9 or 17 weeks gestation. PreT␣ message was detected in all samples and its expression decreased in fetal blood samples with increasing gestational age while C␣ message appeared at 9.4 weeks and its expression increased during gestational age. T cell clones obtained from fetal liver cells showed a mature TCR ␣␤ + , CD8 + phenotype and displayed strong alloreactivity against allo-MHC class I molecules. The presence of alloreactive T lymphocytes may explain the failure to engraft in fetuses older than 13 to 16 weeks and may provide insights into fetal liver transplantation. Bone Marrow Transplantation of gestation have been transplanted into fetuses at the 13th to 18th week of gestation. 6-8 Considerably better results have been obtained in fetuses affected by immunodeficiency syndromes such as SCID or Bare Lymphocyte diseases. 1,9 These findings raise the possibility that the fetus may develop an allogeneic immune reaction responsible for graft failure. Accordingly, fetal liver HSC were capable of engraftment in syngeneic, but not allogeneic recipient mice, 10 and successful allogeneic in utero transplantation of fetal HSC in sheep and monkeys occurred if both the donor and recipient fetuses were in a preimmune status. 5 Furthermore, we have recently reported 7 that in utero transplantation of an 18 week fetus with fetal HSC resulted in graft failure and after birth the recipient had a very high cytotoxic T cell precursor (CTLp) frequency against donor cells, thus indicating that generation of an alloimmune response rather than tolerance induction was the effect of the procedure.The development of T lymphocytes starts primarily in the embryonic thymus 11-13 after 8 weeks gestation, where they undergo a complex series of differentiation events leading to the expression of the T cell receptor (TCR) complex. 14 Efficient performance of this program appears to be dependent on cellular interactions between developing thymocytes and thymic stromal components. 15 These cells may then colonize the periphery, including the fetal liver itself, as the presence of phenotypically mature T cells has been demonstrated in 11-13 to 22 week old fetal livers. 16 Moreover, recent studies have shown that the liver is also a site for extrathymic T cell development and maturation. 17 Against this background, we have undertaken molecular, phenotypic ...

The study suggests that public health authorities should act and invest in a similar programme for prevention of thalassaemia, as well as in relation to the increased survival of patients and the consequent organ complications.

The combined use of morphology and DNA analysis makes it possible to select and isolate embryo-fetal cells, even when maternal contamination is high. This development provides the opportunity for the use of celocentesis for early prenatal diagnosis of genetic diseases and application of array comparative genomic hybridization. © 2016 John Wiley & Sons, Ltd.