Experience with intrauterine transfusions for severe Rh alloimmunization in a developing country

Gupte, Snehalata C.; Lulla, Chander; Kulkarni, Shrikant; Korgaonkar, Seema; Walvekar, Vandana; Merchant, Rashid

doi:10.1002/(sici)1520-6661(199811/12)7:6<287::aid-mfm6>3.0.co;2-#

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…Our perinatal survival rate was 50% and it was the lowest rate documented for the last decade 30 . A study in India of 27 cases in which severe hydropic fetuses rate was 40% also showed a 55% perinatal survival rate 31 . The survival rate in 11 severe hydropic cases was 27% similar with our severe hydrops cases.…”

Section: Discussionsupporting

confidence: 76%

Perinatal outcomes and survival predictors of severe red‐cell alloimmunization treated by intrauterine transfusion

Arslan

Demi̇r

Özsürmeli

et al. 2021

J of Obstet and Gynaecol

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Objective To evaluate perinatal survival rates and predictors in severely anemic fetuses that underwent intrauterine transfusion (IUT). Method This was a retrospective study of both Turkish and Syrian patients who underwent IUT for fetal anemia due to Rh alloimmunization between 2015 and 2019. The association between pretransfusion factors and perinatal survival was evaluated by multivariate logistic regression. Receiver operating characteristics (ROC) curves were used to identify the level of fetal hemoglobin deficits that predict perinatal survival. Results Eighty‐seven IUTs were performed in 42 pregnancies. Approximately 75% of fetuses were severely anemic and the overall perinatal survival rate was 50%. The survival rate was better in Syrian refugees compared to Turkish patients (71.4% vs. 39.3%, p < 0.05). In univariate analysis, hydrops presence (odds ratio [OR] = 0.2; 95% confidence interval [CI] = 0.05–0.7; p < 0.05), first IUT week (OR = 1.4; 95% CI = 1.1–1.8; p < 0.05), pretransfusion hemoglobin level (OR = 1.99; 95% CI = 1.22–3.27; p < 0.05), hemoglobin deficit (OR = 0.5; 95% CI = 0.3–0.8; p < 0.05), and birth week (OR = 2.3; 95% CI = 1.3–3.9; p < 0.05) were associated with survival. However in a multivariate analysis, only hemoglobin deficit (OR = 0.47; 95% CI = 0.22–0.99; p < 0.05) and birth week (OR = 3.3; 95% CI = 1.1–10.3; p < 0.05) were found to be associated with survival. On ROC analysis, a hemoglobin deficit of ≤6.25 g/dl showed a sensitivity of 0.95 and specificity of 0.62 for predicting perinatal survival. Conclusion Despite the improvement in the treatment of fetal anemia, perinatal survival rate remains extremely low in severely anemic cases. Among pretransfusion factors, hemoglobin deficit seemed to be most important in predicting survival during fetal anemia.

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Section: Discussionsupporting

confidence: 76%

Perinatal outcomes and survival predictors of severe red‐cell alloimmunization treated by intrauterine transfusion

Arslan

Demi̇r

Özsürmeli

et al. 2021

J of Obstet and Gynaecol

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“… 3 Foetal anaemia is the main risk to foetal survival with severe Rh(D) alloimmunisation. 4 Prophylactic anti-D immunoglobulin is standard treatment in the prevention of alloimmunisation thereby decreasing the rate of foetal anaemia, however it is not widespread in developing countries due to the lack of awareness and availability in remote areas. 5 , 6 Also, once alloimmunisation occurs it cannot be administered during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“… 5 , 6 Also, once alloimmunisation occurs it cannot be administered during pregnancy. 4 It is a modern practice to use maternal plasma in alloimmunised women to determine Rh(D) foetal antibodies. Foetal Rh(D) genotyping uses cell-free foetal DNA from maternal plasma to accurately determine foetal Rh(D) status, thus reducing unnecessary treatment with routine anti-D immunoglobulin and proceed to the appropriate screenings and treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Prescott,

Jackson

2024

Hematology, Transfusion and Cell Therapy

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“…The majority of such cases are associated with Rhesus haemolytic disease [1][2][3]. The incidence of Rh (D) negativity in India is about 5 % [4,5]. Maternal isoimmunization occurs in approximately 1-2 % of Rh (D) negative women [6,7].…”

Section: Introductionmentioning

confidence: 99%

Antenatal Maternal Serum IAT Titer and Fetal Outcome in Rh Isoimmunized Pregnancies

Philip

Jain

2014

Indian J Hematol Blood Transfus

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The incidence of Rh negativity in India is about 1-5 % and the rate of Rh sensitization to be approximately 0.79 % of live births. This study evaluated the role of antenatal maternal serum Indirect Antiglobulin Test (IAT) titre in predicting the feto-neonatal outcome. The study was conducted from Jan 2007 to Dec 2012 at our centre in Pune, Maharashtra, India. This study reports our experience with 75 IUTs carried out for 42 cases of severe Rh isoimmunization. IAT was performed by ID gel cards and test tube method was utilized for titration. Results were analysed by odds ratio (OR) with 95 % Confidence Interval. IAT titre was found to have a direct correlation with the maternal parity, requirement of number of IUT's and adverse fetal outcome. Of the 42 cases of severe Rhisoimmunization who underwent IUT, 11 (26.2 %) had hydropic fetus resulting in 08 (73 %) live babies, two intrauterine and one neonatal death. The remaining 31 (73.8 %) non-hydropic fetuses who received IUT, one intrauterine and one neonatal death were observed. In the 11 hydropic cases, who received IUTs, two intrauterine and one neonatal death were observed in which the IAT titre was C512, which was found statistically significant with OR of 9.77 & P value of 0.05. The overall survival rate was 37/42 (88.1 %). Severity and fetal outcome in Rh isoimmunized pregnancies, showed a significant association with antenatal maternal serum IAT titre. More the antibody titre more would be the fetal and/or neonatal severity with respect to immune hemolytic anemia. Requirement of multiple IUTs are also associated with high antenatal serum IAT titre.

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Experience with intrauterine transfusions for severe Rh alloimmunization in a developing country

Cited by 4 publications

References 18 publications

Perinatal outcomes and survival predictors of severe red‐cell alloimmunization treated by intrauterine transfusion

Perinatal outcomes and survival predictors of severe red‐cell alloimmunization treated by intrauterine transfusion

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

Antenatal Maternal Serum IAT Titer and Fetal Outcome in Rh Isoimmunized Pregnancies

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