European Stars And Stripes (Newspaper) - June 10, 1988, Darmstadt, Hesse                                Delicate technique for treating and monitoring the fetus ultrasound device using ultrasound to View the fetus a physician pastas thin need through the Mother s Abdomen and into the umbilical Cord. The technique allows doctors to draw blood Tor diagnostic tests. H can Ahto a used to Der Var drugs or Gay Wood transfusion As oath a the 18th week of pregnancy. Fetuses treated through umbilical cords by g1na Kolata new York times a promising new technique is allowing doctors to evaluate real and even give blood transfusions 1o Leouses while they Are still in the  the procedure doctors carefully thread a Needle into tiny blood vessels of the umbilical Cord and Hen use the Needle to take samples of Lelal blood to inject drugs or to perform transfusions. The demanding technique developed in France is available in the United states at just a handful of medical can Lars. But experts say that its use is spreading and thai it is fast becoming indispensable the method has really opened up a whole new area of Lelal Medicine said or. Stuart Weiner of the University of Pennsylvania medical school who has used it extensively. The Standard method of evaluating a fetus amniocentesis. Is not Neaily so precise experts oath Wilh Aninion Entelis doctors insert a Needle Inlo inc amniotic fluid thai surrounds a club and withdraw a Small amount of the fluid for study. The fluid contains fetal cells which can indicate whether the fetus has a Genelie disease. For example. But amniocentesis is essentially a Octal time Sample Weiner said. The Luid is produced when the fetus urinates into he fetal Sac. Using Only amniocentesis to diagnose fetal problems is like treating a patient in a Hospital when All you can do is a urinalysis he said Cho ionic villus sampling another method of evaluating a fetus in which hairline projections of the fetal Sac Are la Cen Early in pregnancy supplies doctors with fell chs but does not show defects thai Cio nol Page 16 associated with specific genetic diseases like Down s syndrome Wilh blood samples irom the umbilical Cord on Iho other hand you can gel a Wood count look at liver function blood gasses and acid base  Wemes said. Or Ronald Wil incr of i he Jefferson medical College in Philadelphia said to had treated fetuses whose red blood cells were being destroyed by antibodies from their mothers a condition thai most commonly arises when Mother and child filter in blood proteins called re la clots. These fetuses Are seriously anaemic and although some can survive until birth and be treated wish blood in allusions. Olheis Wilt die in the womb unless they receive transfusions before birth. Wapner said he starts administering transitions As Early As the Ibsh week of pregnancy and continues giving them every two weeks until the babies Are born it s been absolutely amazing tie said. Fredric Frigoletto of Brigham and women s Hospital in Boston said that 80 percent of the fetuses with severe re disease Hal to has treated with the technique survive. The presumption when it s done is thai the fetus would nol survive without treatment to said doctors at i he University of Pennsylvania Are treating a Chicago woman who flies in every two weeks so her Lotus which has re disease can have a blood transfusion she started going to the University of Pennsylvania 10 weeks ago when she was 16wecks pregnant. So far she has had four transfusions and there have Boon no complications because of the procedure. Another woman from Iho Princeton no area went to the University of Pennsylvania about six months ago when she was seven months pregnant. A routine ultrasound examination of her Felus showed that it had substantial fluid accumulations in its Abdomen lungs and skin without lie Almena lha fetus was Likely to die before Bish or to be born Wilh so much fluid in its lungs that in would have great difficulty breathing. At the University of Pennsylvania a More precise ultrasound study showed Hal the Felus had congestive heart failure because irregularities of heart rhythms wore impeding blood flow through the body and leading to the fluid accumulations. Adults with congestive heart failure can be treated with digitalis but it is hard to administer to fetuses because Hie drug Haw York time often does not pass through the Placenta. Weiner injected the drug through the umbilical Cord. We saw an immediate response in tote fetal heart rate he said. Within several Days to a week the excess fluid went  the baby was healthy at birth and his irregular heartbeats disappeared by themselves within a Tew months. The technique was first used in France in 1983, when or. Fernand Daflos of the Hospital de notre Dame de Bon Secours in Paris decided to try to obtain fetal Wood through the umbilical Cord to diagnose toxoplasmosis a serious parasitic disease that can cause a variety of Lelal disorders including blindness. Withing two years alter Delfos began diagnosing toxoplasmosis by sampling fetal blood doctors at several medical centers in the United Stales began attempting the technique practising in first on Leouses of women who planned to have abortions. Weiner who said his group probably has the largest experience with the method has used it on 216 fetuses since october 1985 he also keeps in Contact Wilh doctors at seven other medical centers and maintains a registry of the successes and complications with the technique. Together doctors at the eight medical centers have performed the technique 600 limes he said. The fell death rate from the procedure has been 1.2 percent. The most frequent complication is bleeding from the umbilical Cord which occurs in 15 percent to �0 percent of the procedures but which usually slops on its own. About 1 percent of the women go Inlo labor As a result of the procedure but the labor can usually be slopped by dings. One of the most fearful complications is the risk of infection Weiner said and it has occurred three times in the women he has treated. Most of these infections can be treated by giving the Mother antibiotics he said. Wapner said to and others Are now trying to find a Way to use the technique to test fetuses for infection with the aids virus which occurs in about 40 percent of the fetuses of aids infected mothers. The difficulty is that doctors must pass the Needle through the Placenta in order to reach the fell umbilical Cord. The Placenta contains maternal and fetal blood and the researchers Are concerned that maternal blood might be introduced into the umbilical Cord through the procedure. If the Molher is infected Wilh aids virus the procedure could actually infect the Felos. The stars and stripes Friday june 10,1988