Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization

Early intrauterine transfusion in severe red blood cell alloimmunization

“…IUT is considered a safe procedure with a relatively low procedure-related loss rate of 1-3% 7,9 . However, these figures derive mostly from data on IUTs performed after 22 weeks of gestation, and data on the risk of earlier transfusions are limited.…”

“…However, these figures derive mostly from data on IUTs performed after 22 weeks of gestation, and data on the risk of earlier transfusions are limited. Van Kamp et al reported on a procedure-related loss rate of 5.6% when IUTs were carried out before 20 weeks of gestation and 1% when performed between 20 and 24 weeks of gestation 9 . In our series, the procedure-related fetal loss rate at < 22 weeks of gestation was 10%.…”

“…However, different methods of transfusions were used in our cohort, limiting our ability to determine the complication rate for each method. The ideal site for an early IUT is yet to be established, although no significant difference in complication rate was found when the IHV was compared with the cord root in IUTs performed later in gestation 9,24 .…”

“…In general, intravascular transfusion has been shown to be safe with a loss rate of approximately 1-3% per procedure 5,8 . The safety and efficacy of this procedure has been recently illustrated by a large single-center study of 740 transfusions in 254 anemic fetuses showing a procedure-related loss rate of only 1.6% per procedure 9 . Despite its safety, this procedure imposes a clinically significant stress on the fetal cardiovascular system as a result of acute changes in intravascular volume and viscosity 7 .…”

“…Treatment of fetal anemia caused by RBC alloimmunization in the early second trimester is associated with poor perinatal outcomes 9,10 . At such early stages of gestation, gaining access to the fetal circulation is technically difficult.…”