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The effect of intravascular transfusion on umbilical venous pressure in anemic fetuses with and without hydrops

  • Carl P. Weiner
    Correspondence
    Reprint requests: Carl P. Weiner, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242.
    Affiliations
    Fetal Diagnosis and Treatment Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
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  • Gay D. Pelzer
    Affiliations
    Fetal Diagnosis and Treatment Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
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  • Joni Heilskov
    Affiliations
    Fetal Diagnosis and Treatment Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
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  • Katharine D. Wenstrom
    Affiliations
    Fetal Diagnosis and Treatment Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
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  • Roger A. Williamson
    Affiliations
    Fetal Diagnosis and Treatment Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City, Iowa
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      Human fetal umbilical venous pressure was measured during 20 intravascular transfusions performed for treatment of hemolytic anemia. The mean (±1 SEM) gestational age at the time of transfusion was 29.3 ± 1 weeks and the mean beginning hematocrit was 27% ± 2%. The mean volume of infused packed red blood cells (70% hematocrit) was 90.3 ± 7 ml. The mean hematocrit at completion of the procedure was 48% ± 1%. In nonhydropic fetuses umbilical venous pressure rose progressively from 6.7 ± 1 mm Hg at the start of transfusion to 10.9 ± 1 mm Hg at the completion of transfusion (p < 0.002). However, most fetuses who began the infusion with a normal umbilical venous pressure ended the transfusion with a normal umbilical venous pressure (<10 mm Hg). Fetuses with immune hydrops (n = 2) had elevated umbilical venous pressure values before the initiation of transfusion therapy when compared with the first transfusion of nonhydropic fetuses (12.5 ± 0.5 vs. 5.7 ± 1 mm Hg, p = 0.01). However, the umbilical venous pressure measurements declined into the normal range within 24 hours of the first transfusion; this normalization was too rapid to be explained by the reversal of liver hypertrophy or portal hypertension. There was no demonstrable relationship between the rise in umbilical venous pressure and either the gestational age, the volume transfused, or the rise in hematocrit. This study demonstrated: (1) In terms of the umbilical venous pressure, direct intravenous infusion of the human anemic fetus is well tolerated; (2) the elevated umbilical venous pressure associated with immune hydrops can correct rapidly with red blood cell replacement.

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