Hemovigilance is an important tool not only to analyze blood transfusion incidents, but also to measure the effects of new processes or corrective actions at a national level.

ABSTRACT'. IGF-I, IGF-11, and their binding proteins (BP) were studied in sera obtained by direct puncture of umbilical cords in utero between 20 and 37 wk of gestation in 103 normal fetuses and in 16 fetuses with intrauterine growth retardation, as well as in the cord blood of 37 normal newborns of 38-to 42-wk pregnancies. In normal fetuses, IGF-I levels were approximately 50 ng/mL and IGF-I1 levels approximately 350 ng/mL up to the 33rd wk of pregnancy. Thereafter, both increased to reach values two to three times higher at term. Correlations were found between fetal placental lactogen levels and those of IGF-I and IGF-11, which is consistent with the hypothesis that placental lactogen is involved in the regulation of IGF synthesis in the fetus. With weight (either measured at birth or deduced from echographical data) as index of fetal size, IGF-I levels were significantly ( p < 0.001) higher in fetuses with weights above the mean for gestational age than in fetuses with weights below the mean, whereas IGF-I1 levels were similar in the two groups. Similarly, IGF-I (but not IGF-11) levels in fetuses with intrauterine growth retardation were significantly lower than those in normal fetuses of the same age ( p < 0.01). These findings suggest that, during the latter months of intrauterine life, IGF-I (but not IGF-11) is involved in the control of fetal size. Total fetal BP concentrations were approximately '/J those of adults. The fetal electrophoretic profile obtained by Western-ligand blotting bore a strong resemblance to that of subjects with growth hormone deficiency. In newborns, the proportions of IGF-I and IGF-I1 associated with BP to form 150-kD complexes were considerably lower than those in adults, but similar to those in hypopituitary patients. It may be deduced from these findings that during fetal life, BP synthesis is adapted to increase the bioavailability of the IGF at a time when growth is at a maximum.

For the prenatal diagnosis of congenital T. gondii infection, an approach based on a PCR test performed on amniotic fluid is rapid, safe, and accurate.

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When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease.

ABSTRACT. Utilizing an easy and safe ~rocedure for fetal MATERIALS AND METHODSblood sampling in utero we have studied 409 fetuses for prenatal diagnosis of rubella, toxoplasmosis, hemophilia, and hemoglobinopathies. Retrospectively we selected 163 fetuses confirmed as normal at birth and tested between 18 and 30 wk of gestation to establish normal hematological parameters and to follow the evolution of erythropoiesis, differential counts, hemoglobin synthesis, and hemostasis. Total white blood cell and platelet counts did not change during this period. Our knowledge of fetal hematology is limited due to the fact that most earlier studies were performed on aborted fetuses or under sampling conditions which may have altered hematological values. Moreover, only a few hematological values during gestation have been published (1). Having developed an easy and safe technique for fetal blood sampling, we selected retrospectively for this study 163 fetuses born healthy at full term delivery to establish reference fetal hematological values using standardized methods. To date no fetal loss or premature labor has been attributed to these fetal samplings.Sampling procedure. The fetal sampling method has been described in detail previously (2, 3). A real time ultrasound scanner (ATL MARK 111) was used to locate the umbilical cord insertion on the placenta and to determine the best route of access to it without fetal interposition. The transducer was then maintained immobile while, under aseptic conditions, local anesthesia was performed with 1 % xylocaine into the anterior abdominal wall at the chosen puncture site. No /3-mimetic drugs or other medication were used prior to the procedure. A 20-gauge spinal needle (10 or 13 cm long), filled with 0.129 M sodium citrate solution and fixed to a 2 ml disposable syringe containing 0.1 ml of this solution, was introduced into the plane of the ultrasound sector near the transducer. The needle tip emitted a clearly visible echo and its progress toward the insertion of the cord was followed on the scope. The vein of the cord was punctured about 1 cm from its insertion.Immediately after the first d r o~ of blood was obtained, the syringe was replaced by a new one containing no additive. The blood sample was immediately transferred into special tubes containing adequate anticoagulant for biological studies. The duration of the entire procedure was less than 10 min in 90% of the cases, and the automated evaluations of hematological parameters were completed within 30 min.Patients. We studied 409 pregnancies and 435 fetal blood samplings were camed out (26 repetitive samplings) with the approval of the ethics committee of the hospital, the medical expert panel, and the informed consent of the patients. The fetal samplings were conducted for the prenatal diagnosis of toxoplasmosis (285 cases), rubella (37 cases), or hemophilia (30 cases), for rapid fetal karyotyping (32 cases), or for diagnosis of other miscellaneous conditions (25 cases). Medical abortions of affected fetuses were perfor...

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