Fetal Haemoglobin Measurement in the Assessment of Red Cell Isoimmunisation

Nicolaides, Kypros H.; Clewell, William H.; Mibashan, R. S.; Soothill, Peter; Rodeck, Charles H.; Campbell, Stuart

doi:10.1016/s0140-6736(88)91896-x

Cited by 235 publications

(148 citation statements)

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“…The pattern of a relative reduction in flow with growing gestational age has been reported in previous studies of the umbilical circulation (14 -16,33) and appears to be linked to a reduced proportion of fetal cardiac output directed to the placenta (34). This is, however, partially compensated by an increasing Hb concentration (35) and a more efficient transplacental transport (36). In contrast to the umbilical circulation, we recently demonstrated that normalized blood flow in the PV showed an increase after 30 -32 gestational weeks (18) signifying a more prominent role of the splanchnic circulation (Fig.…”

Section: Discussionsupporting

confidence: 70%

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

et al. 2008

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Recent data suggest that umbilical venous perfusion of the fetal liver has an important influence on fetal growth and postnatal liver function, and that maternal factors in late pregnancy modify this circulation. In a longitudinal study of 160 low-risk pregnancies, we determined how umbilical and portal venous blood flows to the fetal liver changed during gestation, and examined the hypothesis that maternal body mass index and pregnancy weight gain influenced fetal liver blood flows. We measured blood flows in the umbilical and portal veins, left portal branch, and ductus venosus using ultrasound. Normalizing for estimated fetal weight, fetal liver total venous blood flow fell from 84 to 57 mL ⅐ min Ϫ1 ⅐ kg Ϫ1 during 21-39 wk of gestation; toward term the portal contribution increased (from 14 to 20%) and the umbilical contribution fell, whereas distribution between the left and right liver lobes was stable, 60%/ 40%. Greater flow of nutrient-rich umbilical venous blood to the liver was associated with higher birth weight and neonatal ponderal index. Maternal body mass index was not related to fetal liver blood flows, but low pregnancy weight gain strongly influenced flow distribution between the right and left liver lobes, sparing the left lobe and increasing the difference between lobes by 16%. T he developmental origins of health and disease hypothesis established a link between an adverse intrauterine environment and cardiovascular disease in adult life (1,2). There is strong evidence from epidemiologic studies and animal experiments that an adverse intrauterine environment is associated with raised levels of cardiovascular risk factors controlled by the liver (3). The role of the fetal liver for intrauterine growth and development has therefore come into focus of research.In fetal sheep, experimental reduction in umbilical venous liver perfusion results in decreased synthesis of insulin-like growth factors by the fetal liver, decreasing the cellular proliferation rate in peripheral tissues and impairing fetal growth (4,5). In human fetuses, venous liver blood flow was shown to be modulated by maternal diet and body composition (6).The fetal liver receives venous blood from the umbilical and portal veins (PVs). The umbilical vein (UV) directs nutrient-rich placental blood predominantly to the left liver lobe, whereas nutrient-depleted blood from the PV is directed to the right liver lobe (7). This selective perfusion pattern is thought to be the main reason for differences in micro architecture (8), hematopoiesis (9) and gene and enzyme expression (10,11).Although single components of the venous liver circulation such as umbilical blood flow (12-14) and shunting through the ductus venosus (DV) (15,16) have been investigated earlier, little is known about the distributions of umbilical and portal blood flows in the human fetus.The aim of the present study was to study simultaneously the umbilical and portal venous circulations and the blood flow distribution to the liver lobes in the second half of ...

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Section: Discussionsupporting

confidence: 70%

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

et al. 2008

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“…In normal pregnancy, blood decreases PuvO2 and the haemoglobin concentration increases with gestational age.8 9 To allow for this gestational effect, the individual values of PUvO2 and haemoglobin in this study were expressed as SD scores (z scores) using the appropriate normal mean (SD) value for that gestational age.8 9 Subsequent regression analysis, fitting an exponential model, and using a computerised statistical package (Statview) has been used to determine the significance of any associations between adenosine concentrations plotted on a logarithmic scale, and the z score for PUVO2 or haemoglobin concentrations. Adenosine concentrations in fetuses with haemoglobin z scores greater and less than -2 were further compared using non-parametric statistics.…”

Section: Discussionmentioning

confidence: 99%

Fetal anaemia and its relation with increased concentrations of adenosine.

Russell

Greenough²,

Lagercrantz³

et al. 1993

Archives of Disease in Childhood

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Adenosine concentrations were measured in umbilical venous blood obtained by cordocentesis from 14 fetuses of 19-34 weeks' gestation. The concentration did not change significantly with gestational age, but anaemic fetuses showed significantly increased concentrations of adenosine and there was a positive association with blood oxygen tension. These findings suggest that the fetus responds to tissue hypoxia by increasing blood adenosine concentrations from at least 19 weeks' gestation. (Arch Dis Child 1993;68:35-6) Postnatal studies of infants who had been subjected to perinatal asphyxia have reported increased concentrations of catecholamines,' adenosine, and hypoxanthine in blood samples.2 5 Cordocentesis, ultrasound guided umbilical venous blood sampling, has now made it possible to investigate the metabolic consequences of intrauterine hypoxia. Previous work, using cordocentesis samples from rhesus isoimmunised fetuses, showed the presence of hypoxaemia and anaemia, and showed that these abnormalities were associated with increased concentrations of catecholamines.6The aim of this study was to measure adenosine concentrations in fetuses and determine their relation with prenatal hypoxia.

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“…O mé-todo mais fiel para determinar a gravidade da anemia fetal é sem dúvida a avaliação hematimétrica do concepto. No entanto, a cordocentese para a coleta da amostra do sangue fetal é procedimento de risco, associado a piora da aloimunização maternal e a perda fetal (2) . No meio da década de 90, diversos trabalhos (3-7) estabeleceram que o feto responde à anemia por meio de modificações hemodinâmicas arteriais e venosas.…”

Section: Introductionunclassified

Alterações ultra-sonográficas na gravidez Rh negativo sensibilizada avaliada pela espectrofotometria do líquido amniótico e pela dopplervelocimetria da artéria cerebral média

Nardozza¹,

Camano²,

Moron³

et al. 2006

Radiol Bras

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OBJETIVO: Avaliar e confrontar a presença de alterações ultra-sonográficas nas gestações Rh negativo sensibilizadas, quando a anemia fetal foi determinada ou pela espectrofotometria do líquido amniótico, ou pela dopplervelocimetria da artéria cerebral média. MATERIAIS E MÉTODOS: Observacional descritivo com grupo de comparação. Nosso grupo de estudo foi constituído por 99 pacientes, avaliadas no período de janeiro de 1995 a janeiro de 2004. Foram analisados e comparados dois grupos: 74 gestantes sensibilizadas pelo fator Rh cuja anemia fetal foi acompanhada pela espectrofotometria (grupo SE) e 25 gestantes sensibilizadas pelo fator Rh cuja anemia fetal foi acompanhada pela dopplervelocimetria (grupo SD). Avaliamos a presença ou não de alterações ultra-sonográficas no acompanhamento pré-natal e confrontamos os dois grupos de estudo. RESULTADOS: No grupo cuja anemia fetal foi acompanhada através da espectrofotometria (grupo SE), apuramos modificações placentárias, principalmente o aumento da espessura e sua alteração textural, mais assiduamente que as encontradiças no grupo de gestantes sensibilizadas, em que a anemia foi determinada através da dopplervelocimetria (grupo SD) (64% × 32%, F = 6,294). CONCLU-SÃO: As alterações ultra-sonográficas foram detectadas em dobro quando a anemia foi avaliada pela espectrofotometria em comparação com o grupo seguido pela dopplervelocimetria. Unitermos: Isoimunização; Anemia fetal; Artéria cerebral média; Ultra-som Doppler; Aloanticorpos; Eritroblastose fetal.Ultrasound findings in Rh-alloimmunized pregnancies assessed by spectrophotometric analysis of amniotic fluid and Doppler velocimetry of fetal middle cerebral artery. OBJECTIVE: To evaluate and compare existing ultrasound findings in women with Rh-alloimmunized pregnancies with diagnosis of fetal anemia by spectrophotometric analysis of amniotic fluid or Doppler ultrasound of the fetal middle cerebral artery. MATERIALS AND METHODS: This was an observational descriptive study involving 99 patients evaluated between January 1995 and January 2004. Patients were divided into two groups: 74 Rh-isoimmunized women submitted to spectrophotometry of the amniotic fluid (group S) and 25 Rh-isoimmunized women submitted to Doppler ultrasound of fetal middle cerebral artery (group D) to evaluate fetal anemia. Ultrasound findings in the two groups were compared. RESULTS: Placental anomalies, mainly placentomegaly and textural irregularities were more frequently seen in pregnant women followed up with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound (64% × 32%, F = 6,294). CONCLUSION: The frequency of abnormal ultrasound findings was 2-fold higher in pregnancies evaluated with spectrophotometry of the amniotic fluid compared to those followed up with Doppler ultrasound. INTRODUÇÃOA aloimunização pelas células vermelhas do sangue é caracterizada por ser distúrbio imunológico conseqüente a incompatibilidade sanguínea materno-fetal, que determina doença hemolítica no feto e recém-nascido. Há dest...

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Fetal Haemoglobin Measurement in the Assessment of Red Cell Isoimmunisation

Cited by 235 publications

References 13 publications

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

Longitudinal Study of Umbilical and Portal Venous Blood flow to the Fetal Liver: Low Pregnancy Weight Gain is Associated With Preferential Supply to the Fetal Left Liver Lobe

Fetal anaemia and its relation with increased concentrations of adenosine.

Alterações ultra-sonográficas na gravidez Rh negativo sensibilizada avaliada pela espectrofotometria do líquido amniótico e pela dopplervelocimetria da artéria cerebral média

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