Intrauterine rescue transfusion in monochorionic multiple pregnancies with recent single intrauterine death

To assess the role of fetal blood sampling and intrauterine transfusion in monochorionic (MC) multiple pregnancy complicated by single intrauterine death (IUD), we reviewed ten cases over a 4-year period in a tertiary referral centre which underwent fetal blood sampling within 24 h of death of its MC co-twin. Intrauterine rescue transfusion was performed in all seven anaemic fetuses (hematocrit; Hct<30%) to raise the fetal Hct to ≥40%. The rationale was to prevent death and/or brain injury. Two fetuses, which were severely acidaemic at blood sampling, died in utero within 24 h of the procedure. In two cases, the surviving twins manifested abnormal sonographic findings of the fetal brain 2–5 weeks later and underwent late termination. In two cases, the pregnancies continued uneventfully until delivery at 35 and 40 weeks' gestation with good neonatal outcome. In one case the co-twin delivered 1 week later at 29 weeks but died within 12 h. Fetuses without anaemia were not transfused and had normal clinical outcomes. We suggest that intrauterine rescue transfusion before the development of severe acidaemia in anaemic surviving MC co-twins may prevent fetal death, but does not necessarily prevent brain injury. Until its role becomes clearer, we recommend that its use be restricted to situations in which the parents and the local jurisdiction allow late termination as an option if brain injury subsequently manifests on ultrasound. Copyright © 2001 John Wiley & Sons, Ltd.     

施工过程安全数字孪生模型的构建和应用*

为解决施工过程安全信息的虚实交互难题,降低施工过程安全风险,提出施工过程安全数字孪生模型。建立施工过程安全语义本体,分析施工过程安全关键知识要素;定义施工过程安全数字孪生五维模型,明确模型的构成和功能,基于物联网和有限状态机构建施工过程安全监控方法,并以塔吊顶升活动安全监控为例进行应用。研究结果表明:该模型能够实现塔吊顶升施工过程安全的数字化表达、参数化监测和自动化控制。