Premature delivery

Modern neonatal intensive care has dramatically increased survival rates of very premature infants born at 24-30 weeks' gestation. Nevertheless, morbidity is high and premature delivery is now, due to the success of intrauterine transfusions, rarely performed. It is sometimes considered at 36 weeks for

Figure 16.7 Middle cerebral artery Doppler. Peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anaemia due to maternal red cell alloimmunization. Open circles indicate fetuses with either no anaemia or mild anaemia (> 0.65 multiples of the median Hb concentration). Triangles indicate fetuses with moderate or severe anaemia (< 0.65 multiples ofthe median Hb concentration). The solid circles indicate the fetuses with hydrops. The solid curve indicates the median peak systolic velocity in the middle cerebral artery and the dotted curve indicates 1.5 multiples ofthe median (courtesy of Professor Charles Rodeck).

Figure 16.7 Middle cerebral artery Doppler. Peak velocity of systolic blood flow in the middle cerebral artery in 111 fetuses at risk for anaemia due to maternal red cell alloimmunization. Open circles indicate fetuses with either no anaemia or mild anaemia (> 0.65 multiples of the median Hb concentration). Triangles

Figure 16.8 Fetal Hb concentration of 48 hydropic (open circles) and 106 non-hydropic (closed circles) fetuses from red cell isoimmunized pregnancies at time of first blood sampling. Values are plotted on the reference range of fetal Hb for gestation. The individual 95% confidence intervals of the normal Hb for gestation define zone I and the individual 95% confidence intervals of the Hb for gestation of the hydropic fetuses define zone III. Zone II indicates moderate anaemia (courtesy of Professor Charles Rodeck).

fetuses suffering from haemolytic disease due to antibodies other than anti-D, -c or -K. When the previous obstetric history is poor, the mother starts with a high level of anti-D and the partner is homozygous for D, or the fetus is known to be D positive, IVIg is given to carry the pregnancy to 20 weeks, when intrauterine transfusions can be started. In several countries, IVIg is the mainstay of therapy throughout pregnancy.

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