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The Marsh titration score combined with the indirect Coombs' titers of a mother's blood augments the the prediction of anemia in the fetus due to hemolytic disease caused by RH factor incompatibility. Forty-seven blood samples of pregnant women whose blood antibodies already showed evidence of fetal anemia were analysed by indirect Coombs' titer, Marsh titration score, and monocyte monolayer assay. The results were compared with with their fetuses' hematocrits and antigen status for RH factor. The Coomb' and Marsh titers were higher in mothers with anemic children, but the monocyte monolayer activity test in the mothers did not distinguish between the RH positive with anemia, RH positive without anemia, and RH negative fetuses.

There is a strong correlation between the fetal biophysical profile score and umbilical venous pH values. The fetal biophysical profile score uses ultrasonography to evaluate fetal breath movements, body movements, heart-rate reactivity, tone and amniotic fluid volume. It can be used to diagnose fetal asphyxia. A total of 493 fetal biophysical profile score assessments were made. These scores were compared with an equal number of samples of umbilical blood pH values. All fetuses tested were considered to be at high risk for either intrauterine growth retardation or severe anemia requiring transfusion. A measure of the relative acidity or alkalinity of a solution is known as the pH. Low biophysical profile scores were associated with a pH of less than 7.20. A high score of 10 of 10 was always associated with a pH of greater than 7.20. This suggests that in cases of fetal asphyxia both an abnormal physical profile score and an acidic pH will be present.

The development of secondary fetal anemia in association with maternal red blood cell alloimmunization requires hemolysis. In specimens obtained at the time of a clinically indicated cordocentesis, total and direct umbilical venous bilirubin was measured and the indirect umbilical venous bilirubin calculated in 43 antigen-positive and 30 control fetuses. Twenty-two (51%) of the antigen-positive fetuses had or subsequently developed severe anemia (hematocrit 3 mg/dl represented the warning line. Fifteen of 16 (94%) fetuses in whom either severe antenatal anemia or significant postnatal hyperbilirubinemia developed had an umbilical venous total bilirubin >3 mg/dl. We conclude that the normal placental capacity for the transport of fetal bilirubin is exceeded in the face of enhanced fetal hemolysis. An elevated fetal bilirubin often preceds the development of antenatal anemia. The antigen-positive fetus with an elevated bilirubin is at high risk to develop anemia antenatally. (Am J Obstet Gynecol 1992;166:1449-54.)

A prospective study (1988 to 1990) to evaluate the risk of fetal cytomegalovirus transmission was conducted with 1771 pregnant women; the test results of 861 were seronegative (48.6%). At each prenatal visit they were tested for serologic data and cytomegalovirus excretion in urine, saliva, and cervical secretions. If seroconversion occurred (with or without cytomegalovirus excretion), ultrasonography, amniocentesis, and cordocentesis were performed at 22 weeks' gestation; 7 cases of primary cytomegalovirus infection were investigated. In 5 cases the amniotic fluid cultures were positive; in 3 cases the fetal blood test results were positive for specific immunoglobulin M; and in 2 cases brain ultrasonography results were positive. Infection was confirmed with biopsies of fetal tissue. In two other cases, the cord blood and amniotic fluid test results were negative, and the neonates were free of infection. (Am J Obstet Gynecol 1992;166:91-4.)

Fetal hemolytic disease is characterized by destruction of fetal red blood cells, which can result in severe anemia in the fetus. In some pregnancies, the mother's body produces antibodies that destroy fetal red blood cells and thereby cause this condition. Such fetuses usually require blood transfusions. Traditionally, these transfusions were given intraperitoneally (through the abdomen), although now simple intravascular transfusions, directly into the umbilical vein, are used in some hospitals. Cordocentesis is an easily performed technique for obtaining blood samples from the umbilical cord. These samples can be used to monitor red blood cell counts in the fetus. This study examined the effectiveness of treating fetal hemolytic disease by giving the fetus simple intravascular transfusions. Transfusions were given whenever it was deemed necessary on the basis of results of regular cordocentesis. A total of 142 transfusions were given to 48 fetuses based on monitoring with cordocentesis. Only two fetuses did not survive, for a survival rate of 96 percent. Of the fetuses that survived, 78 percent were delivered at term. None of the attempted transfusion procedures failed. Side effects of the transfusions were generally minor, with fetal bradycardia (slow heart rate) occurring in 8 percent of cases. In fetuses of at least 32 weeks' gestation, the interval between transfusions averaged four to five weeks. Outcomes were generally better for fetuses who received more than one transfusion. The results indicate that management of fetal hemolytic disease with simple intravascular transfusions and cordocentesis is highly effective. (Consumer Summary produced by Reliance Medical Information, Inc.)