Advertisement

Acid-base status in fetal heart blood in erythroblastotic fetuses: A study with special reference to the effect of transfusions with adult blood

  • Magnus Westgren
    Correspondence
    Reprint requests: Dr. Magnus Westgren, Department of Obstetrics and Gynecology, Karolinska Institute, Danderyd Hospital, S-182 88 Danderyd, Sweden.
    Affiliations
    Department of Obstetrics and Gynecology and the Department of Biomedical Statistics and Scientific Computing, KingFaisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
    Search for articles by this author
  • Anders Selbing
    Affiliations
    Department of Obstetrics and Gynecology and the Department of Biomedical Statistics and Scientific Computing, KingFaisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
    Search for articles by this author
  • Magnus Stangenberg
    Affiliations
    Department of Obstetrics and Gynecology and the Department of Biomedical Statistics and Scientific Computing, KingFaisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
    Search for articles by this author
  • Robert Phillips
    Affiliations
    Department of Obstetrics and Gynecology and the Department of Biomedical Statistics and Scientific Computing, KingFaisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Blood gas levels, pH, and lactate concentration were studied in fetal heart blood on 70 occasions in 26 fetuses with erythroblastosis. A decreasing hemoglobin concentration correlated to a fall in pH (p = 0.006) and bicarbonate (p = 0.015) and to a rise in base deficit (p = 0.002) and lactate concentration (p = 0.05). Twenty of the fetuses underwent 63 intracardiac transfusions. A multivariance analysis for hemoglobin concentration, percentage of fetal to adult blood, and different acid-base parameters revealed a significant correlation between the presence of adult blood and a rise in Pot (p = 0.047), but failed to demonstrate any correlation to the other studied acid-base variables. Thus the present study suggests that the fetus can compensate for the physiologic properties of adult hemoglobin that are disadvantageous to itself by increasing P02 and thereby maintaining oxygen supply. The physiologic background and the clinical implication are discussed. (Am J Obstet Gynecol 1989;160:1134-8.)

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Rodeck CH
        • Holman CA
        • Karnicki J
        • Kemp JR
        • Whithmore DN
        • Austin MA
        Direct intravascular fetal blood transfusion by fetoscopy in severe rhesus isoimmunization.
        Lancet. 1981; 1: 625-627
        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        Effect of anemia on fetal acid-base status.
        Br J Obstet Gynecol. 1987; 94: 880-883
        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        • Clewell WH
        • Lindridge J
        Relationship of fetal hemoglobin and oxygen control to lactate concentration in Rh-isoimmunized pregnancies.
        Obstet Gynecol. 1987; 69: 268-271
        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        • Bellingham AJ
        The effect of replacing fetal hemoglobin with adult hemoglobin on blood gases and acid-base parameters in human fetuses.
        Am J Obstet Gynecol. 1988; 158: 66-69
        • Westgren M
        • Selbing A
        • Stangenberg M
        Fetal intracardiac transfusion in patients with severe rhesus isoimmunization.
        Br Med J. 1988; 296: 885-886
        • Bohr C
        • Hasselbach KA
        • Krogh A
        Uber einen in biologischen Beziehung wichtigen Einfluss den die Kohlen souer spanning des Bluten auf dessen Sauerstaffbinding ubt.
        Scand Arch Physiol. 1904; 16: 402-413
        • Parer JT
        • Jones WD
        • Metcalfe J
        A quantitative comparison of oxygen transport in sheep and human subjects.
        Respir Physiol. 1967; 2: 196-206
        • Daffos F
        • Cappela-Pavlovsky M
        • Forestier F
        Fetal blood sampling during pregnancy with use of a needle guided by ultrasound: a study of 606 consecutive cases.
        Am J Obstet Gynecol. 1985; 153: 655-692
        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        • Gamsu H
        Blood gases and acid-base status of the human second-trimester fetus.
        Obstet Gynecol. 1986; 68: 173-176
        • Weiner CP
        Cordocentesis for diagnostic indicators: two years' experience.
        Obstet Gynecol. 1987; 70: 664-668
        • Rose BD
        Clinical physiology of acid-base and electrolyte disorders. McGraw-Hill, New York1984
        • Peeters LL
        • Sheldon RF
        • Douglas Jones M
        • Makowski EL
        • Meshchia GF
        Blood flow to fetal organs as a function of arterial oxygen content.
        Am J Obstet Gynecol. 1979; 135: 636-645
        • Jouppila P
        • Kirkinen P
        Umbilical vein blood flow in the human fetus in cases of maternal and fetal anemia and uterine bleeding.
        Ultrasound Med Biol. 1984; 10: 365-370
        • Rightmore DA
        • Nicolaides KH
        • Rodeck CH
        Fetal blood velocity in Rh-isoimmunization: relationship to gestational age and to fetal hematocrit.
        Obstet Gynecol. 1986; 68: 233-238
        • Soothill PW
        • Nicolaides KH
        • Rodeck CH
        • Campbell S
        Effect of gestational age on fetal intervillous blood gas and acid-base values in human pregnancy.
        Fetal Therapy. 1986; 1: 168-175
        • Battaglia FC
        • Bowes W
        • McGaughey HR
        • Makowski EL
        • Meschia G
        The effect of fetal exchange transfusions with adult blood upon fetal oxygenation.
        Pediatr Res. 1969; 3: 60-65
        • Meschia G
        • Battaglia FC
        • Makowski EL
        • Droegemueller W
        Effect of varying umbilical blood OZ affinity on umbilical vein Pot.
        J Appl Physiol. 1969; 26: 410-416
        • Itskovitz J
        • Goetzman BW
        • Roman C
        • Rudolph AM
        Effects of fetal-maternal exchange transfusion on fetal oxygenation and blood flow distribution.
        Am J Physiol. 1986; 247: 655-660
        • Cohn NE
        • Sacks EJ
        • Heyman MA
        • Rudolph AM
        Cardiovascular responses to hypoxemia and acidemia in fetal lambs.
        Am J Obstet Gynecol. 1974; 120: 817-824