BJOG: An International Journal of Obstetrics & GynaecologyVolume 101, Issue 11 p. 1011-1013 Antenatal fetal therapy for neonatal allo-immune thrombocytopenia with high dose immunoglobulin Klaus Marzusch, Corresponding Author Klaus Marzusch Departments of Obstetrics and Gynaecology, University of Tuebingen, GermanyCorrespondence: Dr K. Marzusch, Department of Obstetrics and Gynaecology, University of Tuebingen, Schleichstrasse 4, 72076 Tuebingen, Germany.Search for more papers by this authorElfriede Wiest, Elfriede Wiest Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorKarl-Heinz Pfeiffer, Karl-Heinz Pfeiffer Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorGisela Grubbe, Gisela Grubbe Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorMartina Schnaidt, Martina Schnaidt Departments of Anaesthetics and Transfusion Medicine, University of Tuebingen, GermanySearch for more papers by this author Klaus Marzusch, Corresponding Author Klaus Marzusch Departments of Obstetrics and Gynaecology, University of Tuebingen, GermanyCorrespondence: Dr K. Marzusch, Department of Obstetrics and Gynaecology, University of Tuebingen, Schleichstrasse 4, 72076 Tuebingen, Germany.Search for more papers by this authorElfriede Wiest, Elfriede Wiest Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorKarl-Heinz Pfeiffer, Karl-Heinz Pfeiffer Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorGisela Grubbe, Gisela Grubbe Departments of Paediatrics, University of Tuebingen, GermanySearch for more papers by this authorMartina Schnaidt, Martina Schnaidt Departments of Anaesthetics and Transfusion Medicine, University of Tuebingen, GermanySearch for more papers by this author First published: November 1994 https://doi.org/10.1111/j.1471-0528.1994.tb13052.xCitations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References Boshkov L. K. & Kelton J. G. (1989) Use of intravenous gamma-globulin as an immune replacement and an immune suppressant. Transfus Med Rev 3, 82– 120. Bowman J., Harman C, Mentigolou S. & Pollock J. (1992) Intravenous fetal transfusion of immunoglobulin for alloimmune thrombocytopenia. Lancet 340, 1034– 1035. Bussel J. B., Berkowitz R. L., McFarland J. G., Lynch L. & Chitkara U. (1988) Antenatal treatment of neonatal alloimmune thrombocytopenia. N Engl J Med 319, 1374– 1378. Deaver J. E., Leppert P. C. & Zaroulis C. G. (1986) Neonatal alloimmune thrombocytopenic purpura. Am J Perinatal 3, 127– 131. Derycke M., Dreyfuss M., Ropert J. C. & Tchernia G. (1985) Intravenous immunoglobulin for neonatal isoimmune thrombocytopenia. Arch Dis Child 60, 667– 669. Fehr J., Hofmann V. & Kappeler U. (1982) Transient reversal of thrombocytopenia in idiopathic thrombocytopenic purpura by high-dose intravenous gamma globulin. N Engl J Med 306, 1254– 1258. Giovangrandi Y., Daffos F., Kaplan C., Forestier F., MacAleese F. & Moirot M. (1990) Very early intracranial haemorrhage in alloimmune fetal thrombocytopenia. Lancet ii, 310. Kiefel V., Santoso S., Weisheit M. & Mueller-Eckhardt C. (1987) Monoclonal antibody-specific immobilization of platelet antigens (MAIPA): a new tool for the identification of platelet reactive antibodies. Blood 70, 1722– 1726. Lynch L., Bussel J. B., McFarland J. G., Chitkara U. & Berkowitz R. L. (1992) Antenatal treatment of alloimmune thrombocyto-penia. Obstet Gynecol 80, 67– 71. Marzusch K., Schnaidt M., Dietl J., Wiest E., Hofstatter C. & Goelz E. (1992) High-dose immunoglobulin in the antenatal treatment of neonatal alloimmune thrombocytopenia: case report and review. Br J Obstet Gynaecol 99, 260– 262. Mir N. et al. (1988) Failure of antenatal high-dose immunoglobulin to improve fetal platelet count in neonatal alloimmune thrombocytopenia. Vox Sang 55, 188– 189. Mueller-Eckhardt C., Mueller-Eckhardt G. & Willen-Orff H. (1985) Immunogenicity of and immune responses to the human platelet antigen Zw (a) is strongly associated with HLA-B8 and DR3. Tissue Antigens 26, 71– 76. Mueller-Eckhardt C., Kiefel V., Grubert A. et al. (1989) 384 cases of suspected neonatal alloimmune thrombocytopenia. Lancet i, 363– 366. Murphy M. F.. Pullon H. W. H., Metcalfe P. et al. (1990) Management of fetal alloimmune thrombocytopenia by weekly in utero platelet transfusions. Vox Sang 58, 45– 49. Nicolini U., Tannirandorn Y., Gonzalez P. et al. (1990) Continuing controversy in alloimmune thrombocytopenia: fetal hyperimmuno-globulinemia fails to prevent thrombocytopenia. Am J Obstet Gynecoll 63, 1144– 1146. Reznikoff-Etievant M. F. (1988) Management of alloimmune neonatal and antenatal thrombocytopenia. Vox Sang 55, 193– 201. Schneider W. & Schnaidt M. (1981) The platelet adhesion immunofluorescence test. A modification of the platelet suspension immunonuorescence test. Blut 43, 389– 392. Terasaki P. I. & McClelland J. D. (1964) Microdroplet assay of human serum cytotoxins. Nature 204, 998– 1000. Zimmermann R. & Huch A. (1992) In-utero fetal therapy with immunoglobulin for alloimmune thrombocytopenia. Lancet 340, 606. Citing Literature Volume101, Issue11November 1994Pages 1011-1013 ReferencesRelatedInformation

This paper reports a new technique of chorionic villus sampling. A new probe has been developed to allow easier passage and manipulation of the catheter and improve visualization by ultrasound. Our initial experience with this new probe-guided sampling device indicates that it simplifies the operation, and this could improve the success rate.

Bei der transzervikalen Chorionzottenbiopsie gelingt ein aureichender Biopsieerfolg bei der ersten Aspiration nach der BMFT-geförderten Multicenter-Studie (Stand 31.3. 1989) nur in 62,2% (2). Zur Vereinfachung der Chorionzottenbiopsie wurde eine neue modifizierte Entnahmetechnik entwickelt. Dabei wird der flexible Holzgreve-Katheter in einen hohlen starren Spezialsonde geführt. Dadurch wird die Plazierung des flexiblen Aspirationskatheters erleichtert (Menton und Wiest 1990). Inwiefern diese modifizierte Entnahmetechnik zu einer objektiven Verbesserung der Ergebnisse führt, wurde in einer prospektiv randomisierten Studie untersucht.

56 patients with CVS were asked with a standardized questionnaire why they decided to undergo that surgical procedure and how they felt about it. 52 patients said, that their main motivation for CVS was the early diagnosis of a healthy baby. The low health risk of an early performed abruption in case of fetal abnormalities played a secondary role. Concerning the severity of that surgical procedure 44 patients thought, that it was harmless or tolerable and no woman had the feeling that CVS is a fearful intervention. 76% said, that CVS was not painful or only a little bit, 2 patients had the feeling of a painful surgical procedure. The most disagreeable moment during CVS was the hooking of the cervix. There were different opinions comparing CVS stress to amniocentesis stress in patients with a preceding amniocentesis.

In this paper we present a patient with an initially questionable history of neonatal alloimmune thrombocytopenia (NAT) due to materno‐fetal HPA‐la (PLAl) incompatibility. No circulating antibodies were detectable in untreated maternal serum, but an adsorption/elution technique enabled the demonstration of the platelet‐specific anti‐HPA‐la (anti‐PLAl) in maternal serum. Cordocentesis at 35 weeks of gestation revealed a fetal platelet count of 18 × 109/1. Intrauterine platelet transfusion with HPA‐Ia (PLAl)‐negative donor platelets was performed prior to cesarean section.

Die Amniozentese (AZ) gilt als die sicherste Methode der invasiven Pränataldiagnostik und wird üblicherweise in der abgeschlossenen 15./16. SSW durchgeführt. Zusammen mit einer 2-bis 3-wöchigen Kultur- und Auswertungsdauer liegt das Ergebnis schließlich in der 17 bis 19. SSW vor. Um diesen späten Zeitpunkt, der von den Patientinnen als sehr belastend empfunden wird, vorzuverlegen, werden seit 1990 an der UEk Tübingen Frühamniozentesen angeboten, also Fruchtwasserpunktionen zwischen der abgeschlossenen 11. bis 14. SSW.

A case of a deformed ear following chorion villus sampling is described. The possibility of a relation between the described malformation and other malformations following chorion villus sampling is discussed.

A case of a deformed ear following chorion villus sampling is described. The possibility of a relation between the described malformation and other malformations following chorion villus sampling is discussed.

Wir berichten über eine Ohrmißbildung nach einer Schwangerschaft, in deren Verlauf eine Chorionbiopsie durchgeführt wurde. Die Möglichkeit eines kausalen Zusammenhangs zwischen der beschriebenen Mißbildung und anderen aufgetretenen Mißbildungen nach CVS wird diskutiert.

GIFT can be easily and economically introduced into hospitals, and has therefore become widely available in Units unable to offer IVF or cryopreservation facilities (Interim Licensing Authority 1991). However, the number of oocytes transferred back to the patient should be limited to a maximum of three (Interim Licensing Authority 1991) to reduce the risk of multiple pregnancy after GIFT. The use of the IVC (intravaginal culture) technique to transfer supernumerary oocytes and sperm to a local IVF unit with the facilities for cryopreservation provides a simple and cost-effective method for maximizing the chance of achieving a pregnancy per surgical procedure. This has important implications in the structuring ofinfertility services, both within the National Health Service and the private sector. The present report describes the first viable pregnancy achieved following the intra-vaginal transport of embryos from a GIFT unit to an IVF unit for cryopreservation. The modified IVC protocol used in the present study in which the transported supernumerary oocytes were examined for evidence of fertilization 20-24 h after insemination, enables screening for polyspermy. In addition, cryopreservation at the 1 cell pronucleate stage offers improved embryo survival rates compared with cryopreservation at early cleavage stages (Troup et al. 1990). This differs from the original method of IVC (Ranoux ct al. 1988) which involved the culture of embryos for 2 days before they were checked. Whilst it is unlikely that every GIFT unit will be able to provide a cryopreservation service, the present report of a viable pregnancy shows it is possible for IVF centres to provide embryo storage facilities for the GIFT units within their region, with the IVC technique providing a convenient method for transport and culture of oocytes between the two units.

Von August 1987 bis Juni 1990 fanden an der Universitäts-Frauenklinik Tübingen 220 transzervikale Chorionzottenbiopsien statt. Die Indikationen hierzu waren: Erhöhtes mütterliches Alter (77%), psychische Gründe (9%), vorausgegangene Trisomie (8%), balancierte Translokation bei einem Elternteil (1%) sowie genetisch bedingte Erkrankungen, wie Beta-Thalassämie, Muskeldystrophie Duchenne, Hämophilie A., Mukoviszidose, polyzystische adulte Nierenerkrankungen, Tyrosinämie und Wiskott-Aldrich-Syndrom (zusammen 5%).

Ohne Zusammenfassung