Transplacental pharmacokinetics of flecainide in the gravid baboon and fetus

Fetal cardiac interventions

The present article aims to highlight fetal cardiac interventions (FCIs) in terms of indications, strategies, and fetal prognoses. FCIs of the early years were predominantly pharmacological therapies for fetal arrhythmia or heart block. A transplacental transmission of therapeutic agents has now become the main route of pharmacological FCIs. There have been various FCI strategies, which can be categorized into three types: pharmacological, open FCIs, and closed FCIs. Rather than as a routine management for materno-fetal cardiac disorders, however, FCIs are only applied in those fetal cardiac disorders that are at an increased risk of mortality and morbidity and warrant an interventional therapy. Pharmacological FCIs have been well applied in fetal arrhythmias but require further investigations for novel therapeutic agents. The development of open FCI in humans is an issue for the long run. Closed FCIs may largely rely on advanced imaging techniques. Hybrid FCIs might be the future goal in the treatment of fetal heart diseases.

Feasibility of ultrasound-guided percutaneous samplings in the pregnant baboon: a model for studies on transplacental transport

OBJECTIVE

A study was conducted to test the feasibility of cordocenteses and amniocenteses at different gestational ages in pregnant baboons.

STUDY DESIGN

Experiments were performed in 10 pregnant baboons at a median gestational age of 131 (range 92-169) days. At different time intervals, percutaneous samplings of amniotic fluid and fetal blood were performed under ultrasound guidance. Simultaneously, maternal blood samples were drawn.

RESULTS

With a median fetal weight of 431 g (range 111-690 g), 29 of 30 cordocenteses (96.6%) and all 30 amniocenteses and maternal samplings (100%) were successful in obtaining the required quantities for analysis. One cordocentesis was abandoned because of insufficient visualization of the umbilical cord due to a placental haemorrhage.

CONCLUSION

Percutaneous amniocentesis and cordocentesis can be performed with a high success rate in the pregnant baboon model. In combination with a 100% success rate in obtaining simultaneous maternal blood samples, this method is able to provide data on transplacental transport.