Volullle 164 l\'umbcr 1, P.lrt 2

328 SELECTIVE m lC1DE IN THE SECOND TRIMESTER: PERCUTANEOUS ULTRASOUND GUIDED INTRACAROIAC PLACEMENT OF A THROMBOGENIC COIL. M. Shannon Burke\, M,O., Kent Heyborne, M.D.x, Anthony 8rlJno, M"]r.1r~-lITCfiiira'" ~·.'-']Y'orreco, M, D. , Presbyter ian/St. Luke's Perinatal Program, University of Colorado Health Sciences Center, Denver, Co lorado

Ultrasound eva luati on and prenata 1 diagnosis of mu lti pIe gestations may lead to the diagnosis of an anomaly in one fetus not present in the other(s), leaving parents with difficult decisions regarding future management of that pregnancy. Expectant management may result· in the birth of an unwanted abnormal infant, or perinatal complications associated with the anomaly may endanger the normal fetus(es). Selective feticide of the anomalous fetus may be an option in some circumstances, althoLlgh monochorionicity and its attendant angiopagu5 may limit vari aus approaches to thi sal ternat ive. We have managed two cases of twins discordant for anomalies by the placement under ultrasound guidance of a thrombogenic coil in the fetal heart as a simple and effective method of selective feticide. Case 1. 38 year old woman, para 0, who conceived twins following a GIFT procedure had a genetic amniocentesis at 16 weeks gestation showing male fetuses, one of which had Down'~ syndrome. The parents elected selective termination and at 18 weeks 4 days a fetal blood sample reindentified the affected fetus. Ultrasound dir'ected placement of a thrombogenic coil (Target Therapeutics, Inc., San Jose, Calif) was successfully used to effect fetal demise. Case 2. 40 year old woman, para 0, with a twin pregnancy following IVF was seen to have one infant affected with cystic hygromas and non immune hydrops. Amniocytes failed to grow and the parents elected selective termination. At 16 weeks and 1 day ultrasound guided placement of a thrombogenic coil within the heart of the hydropic fetus effected fetal demlse without incident. Both pregnancies are continuing uneventfully at the time of submission of this abstract. CONCLUSION: Intracardiac placement of thrombogenic coils may provide a Simple and safe method of accomplishlng selective feticide.

329 FETAL BLOOD TYPING IN THE SECOND AND THIRD TRIMESTERS USING CHORIONIC VILLI. Karin J. Blakemore, Nancy A. Callan, R. Susan Shirey, Suzanne Nicol, Thomas S. KickIer, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

We have previously shown the utility of chorionic villus sampling (CVS) using an immune rosette method for fetal Rh typing at 9 to 11 weeks of gestation. Small villus samples (2-8 mg) yield 104 - 106 fetal red cells (RBC). With placental maturation, the ability to obtain fetal RBC from chorionic villi might be altered. The purpose of this study was to determine whether CVS is feasible for fetal blood typing at later gestations. Using a 20 gauge needle, 4-12 mg of chorionic villi were aspirated either by CVS or from placentas after delivery. Gestational ages ranged from 17 to 40 weeks (n = 12). By acid elution staining fetal RBC were identified in all 12 preparations (range 12-95%). In the three Rh negative women, the immune rosette method accurately identified Rh positive infants. CVS may be a useful alternative to cordocentesis in Rh sensitized pregnancies when information on fetal blood typing is necessary for patient management.

SPO Abstracts 337

330 RELEASE OF UMBILICAL CORD LOOPS WITH THE HELP OF THE ENDOSCOPE - BM., PETRIKOVSKY, HD., Ph.D., - Dept. OBI GYN - SUNY @ Stony Brook, New York -Moscow Hedical School

We present our experience with endo­scopic release of the DC loops from the fetal neck. A fiberscope GIF-P was introduced through the'cervicaf canal under the constant vision into the amniotic cavity. A single loop of UC around the neck was seen in 18 cases, double or triple loops in 6 cases. In cases when conservative management failed to relieve UC compression we attempted to release the loop of the UC from the fetal neck. The loop of the DC was approached under direct visualization and then elevated and released from the neck by a distal end of the fiberscope shaped as a blunt hook. Loops of the UC were success­fully released in 3 fetuses, loosened in 2 and remained unchanged in 6. Relief of UC compression was followed by normalization of FHR. Thus, mechanical release of the uc loops can be achieved in selected cases.

331 INTRAUTERINE TRANSFUSIONS FOR ISOIMMUNIZATION: POST-PROCEDURE BRADYCARDIA IN LATE THIRD TRIMESTER. Melissa H. Fries. M;[1,x, James D. Goldberg, M.D., Mitchell S. Golbus, M.D.x, Julian T. Parer, M.D., Ph.D. University of California, San Francisco. San Francisco, CA.

Intraperitoneal (IP) lransfusion has been the standard approach for treatment of severe red cell isoimmunization unlil the recent development of ultrasound guided intravascular (IV) transfusion. We present our experience with 35 patients and 108 intrauterine transfusions performed since the introduction of intravascular approaches (1986-1990). These included 64 IV transfusions, 23 IV and IP transfusions, 16 umbilical blood samplings followed by IP transfusions, 2 XP transfusions, and 3 blood samplings only. Fetal survival was 80%, with 30 liveborns (2 neonatal deaths) and 5 stillbirths. 19 transfusions were perfonned at or beyond 32 weeks; 13 of these were IV only. 38.5% (5/13) of these patients underwent emergency cesarean section for bradycardia, either immediately 01' 2-3 hours post procedure. By contrast, 63 transfusions were perfonned from 25-32 weeks, of which 37 were IV only. No post procedure bradycardias were noted after these IV procedures. We recommend continuous and close fetal monitoring in women undergoing transfusion past 32 weeks.