Direct Fetal Intravenous Immunoglobulin Infusion as an Adjunct to Intrauterine Fetal Blood Transfusion in Rhesus-Allommunized Pregnancies: A Pilot Study

Abstract

Objectives: To study the usefulness of direct fetal intravenous immunoglobulin (IVIG) infusion along with intrauterine transfusion (IUT) in the management of severe fetal anemia in rhesus (Rh) alloimmunized pregnancies. Methods: Thirty-four consecutive Rh-isoimmunized pregnant women who required serial IUTs received either blood alone (control group, n = 16) or IVIG and blood (study group, n = 18). Pregnancies were followed up to delivery, and fetal outcome was recorded. The rate of fall of hematocrit was measured and compared between the two groups. Results: There was a slower rate of fall of hematocrit in the study group (IUT and IVIG) compared to the control group (only IUT). The mean rate of fall was 0.72 ± 0.54% per day in the study group while it was 1.29 ± 0.95% per day in the control group (p = 0.005). Conclusion: Fall of fetal hematocrit was reduced in the study group. The results of this pilot study can be used to time the next transfusion in patients receiving IVIG along with IUT (taking the rate of fall as 0.70%). This may eventually result in decreasing the number of transfusions per fetus.

Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn – review on current management and outcome

“…Recently, a prospective case-control study in 34 women compared IUT with fetal IVIG infusion to IUT alone and described a slower hematocrit decline after IUT in the IVIG group [89]. Similar results were found before, but no impact on perinatal outcome was reported [87,88].…”

“…Few fetal therapy centers administrate IVIG directly to the fetus after gaining intraperitoneal or intravascular access [87][88][89]. The increased volume given to the fetus could lead to cardiac compromise.…”

Treatment and Prevention of Rh Isoimmunization

“…However, the results are not promising and the fetus still requires transfusion. Deka et al studied the effect of high dose of IVIg in iso-immunized mother as primary therapy in six patients and found it to be beneficial [31,32]. Deka et al had also studied the effect of direct fetal intravenous transfusion of immunoglobulins and reported that these fetuses required less number of transfusions and the rate of fall in fetal hemoglobin was slower in the intervention group [31,32].…”

Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: a Systematic Review

“…Performing the IUT procedure requires a high level of skill and so reducing the number of transfusions is desirable to prevent the risk of procedure-related (PR) complications including the risk of infections transmitted via blood components. 17 , 18 PR complications include membrane rupture, preterm delivery, chorioamnionitis, and foetal and neonatal death. 8 , 19 The most serious complication during the procedure is foetal distress which can result in emergency preterm delivery or foetal death.…”