Severe fetal hydrops resulting from ABO incompatibility

Article Abstract:

Red blood cells from individuals with type A blood will have a protein on their cell surface known as type A antigen, while those of type B blood have B antigens, AB blood cells have both A and B antigens, and type O blood has no antigens. When a person with type O blood is exposed to type B blood, the immune system begins to make anti-B antibodies to destroy the type B blood cells. This immune response is referred to as ABO incompatibility. When the natural immunity conferred by a type-O mother upon a fetus with type B, the infant's red blood cells are destroyed (hemolytic disease). In rare cases this can lead to fetal hydrops, in which large amounts of watery fluid accumulate inside the fetus. A case is presented of ABO incompatibility that resulted in fetal hydrops. A 30-year-old pregnant woman with type O blood was in her fourth pregnancy. She had previously had two spontaneous abortions and one live birth. During these pregnancies she was exposed to type B blood from the fetus. Usually, this will cause anti-B antibodies of the IgM (immunoglobulin M) type to be formed, which do not cross the placenta and do not harm the fetus. However, in this unusual case, large amounts of anti-B antibodies that could cross the placenta (IgG) were produced by the mother's immune system. Therefore, by the time the woman was in her fourth pregnancy she had large amounts of IgG anti-B antibodies in her blood. At week 34 of pregnancy an ultrasound examination revealed a single fetus with hydrops. The developing fetus had type B blood, and the mother's IgG anti-B antibodies crossed the placenta and caused hemolytic disease and fetal hydrops. At delivery the infant weighed 8.4 pounds, and had anemia (low red blood cell count) and hydrops. After receiving several blood transfusions the infant recovered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications, Erythroblastosis fetalis, Hydrops fetalis

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The occurrence of simultaneous fetal heart rate accelerations in twins during nonstress testing

Article Abstract:

Twin pregnancies have an increased risk of morbidity and mortality, and prenatal health assessment is of particular importance in such cases. Fetal heart rate (FHR) monitoring is one method of evaluating fetal health; however, accurate measurement of each fetal heart is difficult in twin pregnancies because the recordings tend to interfere with one another. Results are reported using a method of FHR measurement in which ultrasound localization of each heart is performed prior to placement of the cardiac monitoring transducer (receives the signal and sends it to the recording device). Nonstress tests (recordings made in the absence of uterine contractions or other planned stressors, such as vibration) were performed for 52 twin pregnancies; 48 were greater than 31 weeks' gestation. Accelerations of the FHR (increase of at least 15 beats per minute lasting longer than 15 seconds) were noted as simultaneous or non-simultaneous. Results showed that the incidence of FHR accelerations in each twin was constant, and that the proportion of simultaneous FHR accelerations was not correlated with gestational age. Approximately 57 percent of all FHR accelerations were simultaneous, a number greater than should occur by chance. One fetal death occurred at the age of 33 weeks following a cord accident; otherwise, the outcomes of all pregnancies were favorable. The findings suggest that intrauterine tactile communication between twins may occur. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Measurement, Fetal heart rate monitoring, Electronic fetal monitoring, Fetal heart rate

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Twin-twin transfusion with abrupt onset of microcephaly in the surviving recipient following spontaneous death of the donor twin

Article Abstract:

A case of twin-twin transfusion in which one fetus died and the surviving twin developed an embolism in the blood vessels of the brain is discussed. Twin-twin transfusion can occur when the fetuses share a placenta and the blood supply transfuses from one twin to the other. A woman who was 23 weeks pregnant with twins had a rapid, significant increase in abdominal size. An ultrasound indicated that one fetus had died. The remaining twin developed swelling of the scalp and skin that resolved 48 hours later. However, abnormalities were noted in the brain, though the size of the head was consistent with the fetus's 23-week-five-day age. Another ultrasound indicated that the surviving twin appeared to have developed of an embolism. The embolism was probably caused by matter transfused from the other fetus. An ultrasound performed five weeks later showed resolution of the embolism. The head measurements however were consistent with those of a 25-week-old fetus instead of 28.

Case studies, Abnormalities, Placenta, Fetal death, Microcephaly

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