摘要:

A reference range for fetal mean red cell volume (MCV) with gestation was established from the study of samples obtained by cordocentesis from 466 pregnancies undergoing prenatal diagnosis for non-erythrocyte abnormalities. The mean MCV decreased from 145 fl at 16 weeks to 113 fl at 36 weeks of gestation. Alterations in MCV were investigated in 154 red cell isoimmunized and 231 small for gestational age (SGA) fetuses. In red cell isoimmunization, significant macrocytosis was observed when the fetal hemoglobin concentration deficit was ≥6 g/dl. In the chromosomally normal SGA fetuses (n = 178), the MCV was increased and the magnitude of macrocytosis was significantly associated with gestation and the degrees of fetal ‘smallness’ and fetal hypoxemia. However, the most severely macrocytotic SGA fetuses were those with triploidy (n = 22). In the SGA fetuses with other chromosomal defects (n = 31), the MCV was higher than the controls but lower than that of the chromosomally normal hypoxemic fetuses. It is suggested that in severe growth retardation there is developmental delay in the normal evolution from hepatic to medullary hemopoiesis and this is most marked in triploid fetuses. In contrast, in red cell isoimmunization the switch to medullary erythropoiesis is normal, but in severe anemia there is secondary recruitment of hepatic erythropo

ISSN:1015-3837    

DOI:10.1159/000263384

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000263458

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000263459

出版商:S. Karger AG    

年代:1989

数据来源: Karger

ISSN:1015-3837    

DOI:10.1159/000263462

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Data from 99 intr-auterine transfusions performed in 30 patients (31 fetuses) with Rh allo-immunization have been reviewed. Mean gestational age at the first transfusion was 23.6 weeks and mean fetal haematocrit 19.8%. The number of procedures was on average 3.2 per fetus. Survival rate was 84%. Fifty-nine intravascular transfusions were combined with intraperitoneal transfusions. Combined intravascular and intraperitoneal transfusions, when compared to intravascular transfusions alone, achieved a significantly longer interval between transfusions and also maintained a higher fetal haematocrit at the subsequent transfusion. Mean fall in fetal haematocrit was 0.98% per day with a wide range. There was a general tendency towards a less marked fall during the second interval between transfusions than in the first with the exception of those cases in which the percentage of fetal red cells at the start of the second transfusion was increased compared to that which was found at the end of the first, i.e., when fetal erythropoiesis was not suppressed.

ISSN:1015-3837    

DOI:10.1159/000263385

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

The author deals with the ethical problems arising from the techniques of prenatal diagnosis and fetal therapy. With regard to the use of prenatal diagnostic response, he underlines the frequent connection between the unfortunate response and the voluntary termination of pregnancy; with regard to this, he reports the various positions which can be found in the literature on ethics. In the light of Catholic ethics, the author affirms that prenatal diagnosis is only acceptable when it respects the life and integrity of the embryo and the human fetus and is directed towards its safeguarding or healing. The moment and form of the communication of the response is also considered. Finally, some guidelines to justify conditions for fetal therapy intervention are pointed out.

ISSN:1015-3837    

DOI:10.1159/000263463

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

In 36 fetuses with congenital diaphragmatic hernia (CDH) diagnosed at 18–36 weeks’ gestation, detailed ultrasound examination was performed for the detection of associated malformations and assessment of the likelihood of pulmonary hypoplasia. In all cases karyotyping was undertaken in blood samples obtained by cordocentesis. In 11 (31 %) fetuses there were lethal chromosomal abnormalities and in 6 (17 %) of the chromosomally normal fetuses there were additional lethal malformations. Of the 17 fetuses with isolated CDH and where the pregnancy was not electively terminated. 9 (60%) survived and 6 (40%) died in the neonatal period due to pulmonary hypoplasia. The presence or absence of polyhydramnios, fetal breathing movements, mediastinal shift and thoracic position of the stomach were not useful in predicting postnatal outc

ISSN:1015-3837    

DOI:10.1159/000263386

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

Several hereditary disorders may be potentially correctable by the introduction and incorporation of the normal gene into human tissues using a variety of systems. Although technical issues surrounding integration, stable expression and potential insertional mutagenesis to the treated cells has not yet been fully resolved, enough scientific progress has already been made to consider somatic cell gene therapy acceptable from both the scientific and ethical viewpoints. Tissue-specific stem cell and embryonic stem cell transplantation will allow therapy earlier in the developing embryo. As technical problems are eliminated, these procedures will become morally permissible, as they will allow the correction of devastating hereditary disease.

ISSN:1015-3837    

DOI:10.1159/000263464

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

In 402 cases with prenatally diagnosed nonimmune hydrops fetalis, cardiovascular diseases were present in 18 %, chromosomal disorders in 11 %, and hematologic disorders of the fetus in 10%. In the last 3 years, fetal blood sampling has become a very important part of the differential diagnosis of nonimmune hydrops (chromosomal, hematologic and metabolic disorders, intrauterine infection). Also, transabdominal placental biopsy has been used for rapid karyotyping. A detailed fetal echocardiogram is absolutely necessary in all cases of nonimmune hydrops, in particular spectral and color Doppler flow mapping. Thus, congenital heart diseases can be accurately diagnosed. Further, in other causes of hydrops regurgitation of atrioventricular valves may be present in advanced stage. New important methods of intrauterine therapy are in particular: intravascular blood substitution in anemia, and the intravascular application of antiarrhythmic drugs in tachyarrhythmia. The overall survival rate was 19.4% (78 of 402); 4.0% (6 of 149) before 24 weeks of gestation, and 28.5% (72 of 253) after this age of gestation. The majority of survivors were in the tachyarrhythmia, hematologic disorder, isolated ascites and hydro-/chylothorax groups (53 of 78 survivors, 68%). In the other groups, the survival rate was generally low.

ISSN:1015-3837    

DOI:10.1159/000263387

出版商:S. Karger AG    

年代:1989

数据来源: Karger

摘要:

While transplantation of fetal tissues may alleviate a great deal of suffering, current policy bars federal funding of research using tissue from elective abortions. Using fetal tissue from spontaneous abortions would obviate the moral concerns. If existing studies of small samples are extrapolated to the US population, then each year about 750,000 fetuses are aborted spontaneously by week 28 (500,000 in the first trimester and 250,000 in the second trimester). The consensus among researchers is that spontaneously aborted fetuses are few in number, and inappropriate for transplantation because they are born dead or have defects. This intuition may not be supported by the evidence, and there is a compelling need to focus research on these issues.

ISSN:1015-3837    

DOI:10.1159/000263388

出版商:S. Karger AG    

年代:1989

数据来源: Karger