Early intrauterine transfusion in severe red blood cell alloimmunization

Abstract

Objective To determine perinatal outcome in pregnancies with early severe red blood cell (RBC) IUT was 20.4 (range,[16][17][18][19][20][21][22] weeks, and between one and nine transfusions were needed during pregnancy. Transfusion was via the intrahepatic vein (IHV) (n = 19), umbilical vein (n = 6) or umbilical artery (n = 2), or was intracardiac (n = 2) or intraperitoneal (n = 1). Overall perinatal survival rate was 80% and did not differ between hydropic and non-hydropic fetuses. Median gestation at delivery, after exclusion of six intrauterine fetal deaths, was 36.7 (range, 27.8-38.4)

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

“…Reported survival rates for IUT series started before 20-22 weeks lie around 76-88% [68][69][70][71]. Lindenburg et al found a fourfold risk of perinatal death after IUTs <20 weeks' gestation, compared to IUTs later in gestation [71].…”

Intra-uterine fetal blood transfusion

“…Owing to substantial risk of amniorrhexis/ preterm delivery and inability to detect fetal anaemia due to Kell alloimmunization or HPVB19 infection, serial amniocentesis is now rarely performed [2]. In contrast, Doppler velocimetry of MCA can be used to screen fetal anaemia secondary to any given aetiology [3]. Knowing that MCA Doppler reliably detect fetal anaemia without fetal or maternal complications, MCA-PSV has become the standard of screening in fetal anaemia.…”

Fetal Intracardiac Transfusions in Hydropic Fetuses with Severe Anemia

“…There are a few cohort studies indicating that IUT before 20 weeks of gestation is still associated with significant fetal mortality [3,6,7,8]. This has been indicated as being predominantly associated with difficulty in obtaining access to the fetal circulation due to the anatomically small size of blood vessels at this gestation and also associations with fetal hydrops, reflecting an overall poor prognostic factor for survival [9].…”

“…In addition, the underlying etiology may have a significant effect on outcome, with human parvovirus B19 infection having a worse outcome, as there may be myocardial impairment in addition to fetal anemia. A small series has indicated that fetal blood sampling and transfusion can be performed at this early gestation [8,11]. We describe a relatively large cohort study comprising 2% of all fetal IUTs performed at the Birmingham Women's Foundation Trust Fetal Medicine Center between March 2004 and September 2014.…”

“…However, intraumbilical transfusion of the fetus has been described in the literature as early as the late first and early second trimester [10]. More contemporaneous cohort studies focusing on fetal transfusion before 20 weeks of gestation indicate fetal loss rates up to 24% [8,11]. Although access to the fetal circulation for transfusion by cordocentesis and intrahepatic vein puncture can be achieved, this may be difficult or impossible, if maternal BMI is significantly increased and/or the baby is hydropic prior to 20 weeks.…”