Intrauterine transfusion with red cells and platelets.

Having direct access to the fetoplacental circulation by ultrasound-directed needle puncture has led to therapeutic interventions for fetal anemia and thrombocytopenia. Most cases of red cell alloimmunization associated with fetal anemia are caused by the antibody to the D red cell antigen. The intravascular transfusion of red cells to a hydropic fetus in such cases has notably improved survival. Nonimmune hydrops fetalis due to maternal parvovirus infection has also been treated successfully with the intravascular transfusion of red cells, whereas fetomaternal hemorrhage has not proved amenable to such therapy. Sensitization to the PLA-1 platelet antigen is the most common cause of fetal thrombocytopenia in maternal platelet alloimmunization. Fetal platelet transfusions have not proved to be a practical therapeutic modality for this disorder owing to the short half-life of the platelets. Platelets transfusions to the fetus just before delivery may avert the need for cesarean section in cases of severe thrombocytopenia.     

Congenital malformation in twins.

Data from the population-based Metropolitan Atlanta Congenital Defects Program (MACDP) show that the overall rate of malformed infants, as well as the incidence of several specific defects, is higher for twins than for singletons. This elevated risk appears limited to same sex twins and, hence, is probably related to monozygosity. In addition to an 18-fold increase in risk of fetal death compared to singletons, twins have almost a 50% greater likelihood of congenital malformation.