There is a lack of high quality evidence to reliably inform clinical practice regarding prenatal bladder drainage in fetuses with ultrasonic evidence of lower urinary tract obstruction. The limited available evidence suggests that prenatal bladder drainage may improve perinatal survival in these fetuses, particularly those with poor predicted prognoses. Further research in the form of a multicenter randomized controlled trial is required to assess the short- and long-term effects of this intervention.

Recent studies have demonstrated that fetal cells can be detected in the maternal circulation during virtually all human pregnancies. These fetal cells can engraft and may be isolated for many decades after pregnancy, leading to a state that may be maintained by the passage of pregnancy-associated progenitor cells. The clinical consequences of fetal cell microchimerism are unclear but may be potentially detrimental or valuable to the mother. One possibility is the generation of an alloreactive immune response by the mother to antigens expressed by the fetus; for example, the HY protein encoded by the Y chromosome. To test this we have screened a cohort of women with a range of parity histories within 8 yr of their last pregnancy for the presence of an HY-specific CD8+ T-cell response. Fluorescent HLA-peptide (HY) tetramers were used to stain short-term T-cell cultures from these women for analysis by flow cytometry. Responses were detected in 37% of women with a history of pregnancies that produced males, and this value rose to 50% in women with two or more pregnancies that produced males. HY-specific CD8+ T cells also could be detected directly in the peripheral blood of women with a history of at least two pregnancies that produced males. These HY-specific CD8+ T cells produced interferon gamma (IFNG) following peptide stimulation, demonstrating their functional capacity. In conclusion, our data indicate that alloreactive CD8+ T cells are generated frequently following normal pregnancy and retain functional capability for years following pregnancy.

This descriptive case study documents the treatment of a cohort of 6 women with pregnancies complicated by red cell alloimmunization who in previous pregnancies had objective evidence of severe fetal anemia prior to 20 weeks of gestation, with accompanying high perinatal loss (66% mortality). In the pregnancies described, 5 singletons and 1 dichorionic, diamniotic twin pregnancy underwent alternate week, serial intraperitoneal transfusions between 16 and 21 weeks, until a gestation when classical fetal intravascular transfusions could be commenced. In addition, 4 women consented to have additional, adjuvant maternal intravenous gammaglobulin (IVIG) therapy (0.8 g/kg per week). At the first fetal blood sampling at a median gestational age of 22 weeks (95% CI 21.2–23.4 weeks) the median hemoglobin concentration was 10.1 g% (95% CI 7.4–13.4 g%). In only 2 cases were the fetal hemoglobin levels at fetal blood sampling between –2 SD and –5 SD for gestational age; in 1 case this was associated with fetal mortality. This cohort indicates that such treatment may prevent severe fetal anemia from developing prior to 20 weeks and, in this cohort, indicated an improved survival of pregnancies (86% survival (6/7)), as compared to the previous history. The only perinatal mortality occurred in a growth-restricted fetus whose mother had a chronic opiate addiction. The fetus died prior to 20 weeks. Of the pregnancies that progressed beyond 20 weeks and commenced classical fetal intravascular transfusions, the survival was 100%.