Berkowitz Rl

Alloimmune thrombocytopenia: Fetal and neonatal losses related to cordocentesis

OBJECTIVEnThis report describes the increased risks of cordocentesis in fetuses affected with alloimmune thrombocytopenia.nnnSTUDY DESIGNnAs part of a multicenter treatment study clinical and laboratory data from five pregnancies with alloimmune thrombocytopenia in which there was a fetal or neonatal loss associated with cordocentesis were reviewed. The fetal or neonatal deaths were all thought to be a result of exsanguination. These fetuses were compared with a group of 44 affected fetuses who underwent the same procedure but who survived. The data were analyzed by the Wilcoxon rank-sum test and the two-tailed Fishers exact test. A p value < 0.05 was considered significant.nnnRESULTSnThe mean platelet count at cordocentesis was significantly lower in the cases than in the controls (5.8 vs 32.8 x 10(9)/L, p = 0.005). The incidence of antenatal intracranial hemorrhage in the untreated sibling of the prior affected pregnancy was significantly greater in the cases than in the controls (two of five vs one of 42, p = 0.02).nnnCONCLUSIONnFetuses affected with alloimmune thrombocytopenia are at increased risk for fatal exsanguination associated with cordocentesis.

Endorphin concentrations in fetal blood during the second half of pregnancy

OBJECTIVE: Endogenous opiates may playa role in both fetal physiologic functions and the adaptation to intrauterine stress. However, our understanding of this role is hampered by an absence of data on circulating levels of these substances during fetal life. STUDY DESIGN: We measured serum J3-endorphin values with a radioimmunoassay in 81 paired fetal and maternal blood samples and 24 neonatal cord specimens. The former samples were uneventfully obtained from uncomplicated pregnancies between 18 and 39 weeks of gestation at the time of cordocentesis for prenatal diagnosis. RESULTS: Mean fetal J3-endorphin concentrations were significantly lower than J3-endorphin values from neonates (90.5 pg/ml [± 59.4] vs 228.4 pg/ml [± 166.2]; p < 0.001), but significantly higher than mean maternal values (70.5 pg/ml (±48.8]; p < 0.02). Although fetal J3-endorphin levels decreased between 18 and 28 weeks gestation, the correlation between fetal J3-endorphin values and gestational age was not significant (r = 0.193; P = 0.07). However, fetal J3-endorphin concentrations were significantly correlated with maternal values (Spearmans rank r = 0.47; P < 0.001). CONCLUSION: These findings suggest that delivery or fetal adaptation to an extrauterine environment is associated with significant increases in J3-endorphin release. Moreover, although the fetal pituitary may be the primary source of circulating fetal J3-endorphin, a maternal or placental contribution cannot be excluded. Our data identify a physiologic range for fetal J3-endorphin concentrations. (AM J OSSTET GVNECOL 1992;167:740-4.)