Medical Therapy
CONGENITAL ADRENAL HYPERPLASIA
Congenital adrenal hyperplasia is a recessively inherited disorder that results in salt wasting. Glucocorticoid replacement is lifesaving, and the long-term prognosis for these children is good. Androgenic cortisol precursors build up in the fetus, and female fetuses typically present with ambiguous genitalia. Mothers of previously affected offspring may be treated with steroids in suppressive doses beginning shortly after conception, which will decrease the production of androgenic steroids in the fetus. Chorionic villus sampling or amniocentesis is performed both to determine the sex of the fetus and for DNA testing for the responsible gene. If testing shows a normal female fetus or a male fetus, the steroids can be stopped; otherwise, steroid therapy is continued through term. Online pharmacy shop order viagra professional with special discounts.
FETAL TACHYARRHYTHMIA
In most cases of fetal tachyarrhythmia (ie, FHR > 180 beats per minute), there is no underlying anatomic congenital heart disease. Children with this condition respond well to treatment, and the long-term prognosis is good. Untreated fetuses may become hydropic, and the mortality under these circumstances is substantial. Digoxin is used to treat children; because it easily crosses the placental barrier, it may be given to a healthy mother to treat the fetus. Only about one third of fetuses respond to digoxin alone, and second-line or alternative regimens such as procainamide, flecainide, and verapamil may be necessary. All of these drugs have potential side effects for both the mother and the fetus.
NEONATAL ALLOIMMUNE THROMBOCYTOPENIA
When a fetus has neonatal alloimmune thrombocytopenia, the mother has a normal platelet count. Fetuses tend to have profound thrombocytopenia, which may result in spontaneous hemorrhage in utero. Various fetal therapies have been suggested, including repetitive platelet transfusions to the fetus. However, in addition to the invasive nature of this therapy, circulating platelets in the fetus have a short half-life. Suppression of maternal antibody production with immune globulin may result in normal platelet counts in the fetus and is protective against bleeding.
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Invasive Fetal Therapy
INTRAVENOUS THERAPY
The most successful and widely used form of invasive fetal therapy is the direct transfusion of erythrocytes to fetuses with erythrocyte isoimmunization. A transfusion can be directed into the fetal peritoneal cavity or intravenously. The latter route has been used more extensively in recent years.
Anemia is the most common other reason to give a fetus erythrocyte transfusions. Fetal anemia usually is discovered during examination of a fetus with nonimmune hydrops. If the fetus is found to be anemic from a reversible cause, fetal therapy may be warranted. The most common etiologies for reversible underlying anemia are a fetal-maternal hemorrhage or parvovirus B19 infection with a resultant fetal hemolytic crisis.
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