Study of fetal hemoglobin with different gestational age and birth weight of the newborn

Background: In many parts of the developing country estimation of antenatal gestational age is still not possible and challenging condition of proper perinatal care. This study aimed to find out relationship between the gestational age and birth weight of the newborn with fetal hemoglobin concentration.Methods: In this comparative study, we included 90 pregnant women who delivered their babies by normal vaginal delivery. Out of these 90 babies, 27 were preterm with gestational age 28-36 weeks, 55 were term with gestational age 37-41 weeks and remaining 8 were post term with gestational age of more than 41 weeks. All these 90 newborn infants were also divided into two groups: low birth weight (birth weight <2.5 kg) and birth weight ≥2.5 kg. Fetal hemoglobin was estimated by using alkali denaturation technique of Chernoff and Singer on appropriate spectrophotometer. Statistical analysis was performed using SPSS windows version 20.0 software.Results: The total number of newborns were significantly (p<0.001) higher in term group and with normal birth weight group. Fetal hemoglobin level was significantly (p<0.0001) lower in term, post term and normal birth weight groups. Study showed a definite negative correlation between gestational age and the fetal hemoglobin concentration. Fetal hemoglobin level was gradually declining with increasing gestational age and birth weight.Conclusions: It is concluded from this study that the concentration of fetal hemoglobin decreases at the rate of 2.4% per week with considerable variation of values at every week of advancing gestational age. Hence level of fetal hemoglobin estimation can be taken as an important criterion for evaluation of gestational age.

A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma

Objectives Chorioangiomas (CAs) are the most frequent tumor-like-lesions of the placenta. Giant CAs (more than 4–5 cm in diameter) is rare and may result in severe maternal fetal complications. Case presentation A 38-year-old multigravida presented at 31 weeks’ gestation with contractions. Upon evaluation, contractions were spontaneously ceased, and the cervix was closed. Ultrasound examination revealed a single viable fetus, polyhydramnios and a 75 x 48 x 82 mm vascular lesion located on the placental surface near the cord insertion. Doppler assessment was suggestive of fetal anemia with middle cerebral artery-peak systolic velocity (MCA-PSV) 1.8 MoM’s. Fetal heart rate monitoring and biophysical scores were reassuring. Following betamethasone fetal cord sampling that revealed fetal hemoglobin level of 8.8 g/dL, 57 cc of blood was transfused resulting in final hemoglobin level of 14.3 g/dL measured prior to needle extraction. MCA-PSV was normalized immediately after the procedure, however aggravated at the following day with MCA-PSV 65 cm/s (1.46 MoM’s). No other intervention was taken and MCA-PSV continued to fluctuate from slight to severe anemia spontaneously over a period of two weeks. At 34 gestational weeks, the women delivered a healthy baby. Fetal hemoglobin level at delivery was 21 g/dL. Conclusions Fetal blood transfusion is a reasonable treatment for fetal anemia in cases of giant chorioangiomas. Following transfusion, MCA-PSV may act unexpectedly reflecting various mechanisms affecting the flow.