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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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Article Info
Footnotes
This research was supported in part by grant HD24494 (C. P. W.) from the United States Public Health Service.
Presented in part at the Thirty-sixth Annual Meeting of the Society for Gynecologic Investigation, San Diego, California, March 15–18,1989.
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Copyright
© 1989 Mosby. Published by Elsevier Inc. All rights reserved.
