A simple device for administering drugs directly to the fetus during birth

A simple device for administering

drugs

directly to the fetus during birth T. Basel,

H.

LIPPERT,

M.D.

Switzerland

A simple device with into the fetus during treatment of acidosis

which it is possible to birth is described. This and hypoglycemia.

inject or infuse medication device

could

be particularly

subcutaneously useful in the

plastic shell (6 mm. diameter) filled with a molten plastic (Araldite) which solidifies, so holding the needles and polythene tubing firmly in position inside the carrier. The spiral needles protrude from the carrier to an

A S T H E F I E L D of perinatology develops to an ever-increasing extent, the problem arises of how to treat the fetus without involvement of the mother. Although numerous animal experiments have been reported, as always, the results cannot be applied directly to human beings. The gap in knowledge concerning human fetal pharmacology mainly is due to the technical difficulties of approaching the fetus directly. Such treatment of the fetus during pregnancy is not new (e.g., in cases of Rh sensitization), but little is known about treating the fetus directly during birth in spite of greater ease of access to the presenting part. With intensive care supervision (continuous recording of fetal heart rate and intrauterine pressure), some of the dangers to the fetus can be recognized in the early stages. In some cases, direct treatment of the fetus with medicaments may overcome the threat and so avoid operative procedures. The present report describes a simple device with which it is possible to inject or infuse medicaments subcutaneously into the fetus sub partu. The principle of the corkscrew electrode, as described by Jungel and by Ruettgers and Kubli,2 has been used. Instead of the solid steel spirals of the scalp electrode two hypodermic needles (external diameter 0.6 mm.) are bent also forming spirals and are connected to polythene tubing (Fig. 1) . The cylindrical carrier consists of a From the Department of Gynaecology and Obstetrics, University of Basel.

Fig. 1. Injection 1112

device.

Volume Number

Device for fetal drug administration

112 8

extent of 3 mm. The entire device may be sterilized and reused. With an amnioscope, the needles are screwed into position on the fetal presenting part by applying forceps to the carrier and the device can remain in position during the course of birth. Mucopolysaccharidase should be injected prior to the drug solution to speedabsorption and to avoid swelling at the site of injection. The use of mucopoiysaccharidase for this purpose has already been described by Phillips and associates,3who injected glucagon directly into the fetal scalp. Preliminary tests have shown that absorption of fluid injected in this way is good and

during

birth

1113

no resultant swelling is apparent in the fetal scalp after birth. Up to the present time, little is known about the possibilitiesof treating the fetus in such a way but, in the conditions of acidosis and hypoglycemia, such treatment is obviously relevant. Using the visible presenting part of the fetus as site of injection has distinct advantages to approaching the fetus blindly via the maternal abdominal and uterine walls as reported by Mendez-Bauer and associates.*The device here described offers a simple and safe means of injecting medicaments directly into the fetus during birth.

REFERENCES

1.

j;;g”;965

D.:

Geburtshilfe

Frauenheilkd.

29:

4.

Mendez-Bauer,

C.,

Poseiro,

J.

J.,

Caldeyro-

Barcia, R., Arellano-Hernandez,G., and Zam2. 3.

Rue)ttgers,’ H., and Kubli, F.: Geburtshilfe Frauenheilkd. 31: 654, 1971. Phillips, L., Lumley, J., Paterson, P., and Wood, C.: AM. J. OBSTET. GYNECOL. 102: 371, 1968.

brana, 1033,

M. A.: 1963.

Arc.

Schanrenstrasse 46 4000 Basel, Switzerland

j.

OBSTET.

GYNECOL.

85: