Intravenous Fetal Exchange Transfusion before 22 Weeks of Gestation in Early and Severe Red-Cell Fetomaternal Alloimmunization

Abstract

Objectives: To determine the perinatal outcome in severe red-cell fetomaternal alloimmunization. Methods: Retrospective series of 32 affected fetuses treated with intravenous fetal exchange transfusion (IFET) before 22 weeks of gestation. The main outcome measures were the degree of fetal anemia, fetal transfusions and perinatal outcome. Results: The first IFET was performed at 19.8 ± 1.8 weeks of gestation. All fetuses were severely anemic and hemoglobin levels were not different between 20 hydropic and 12 nonhydropic fetuses (4.1 ± 2.5 vs. 5.6 ± 2.8 g/dl, p = 0.33). The initial maternal anti-D level ranged from 4 to 76 µg/l and was not correlated to fetal anemia (r = –0.07). Conclusion: The overall perinatal survival rate was 78% compared to a previous perinatal loss rate excluding first pregnancies of 55.5%.

Early intrauterine transfusion in severe red blood cell alloimmunization

“…This is further supported by Poissonnier et al, who showed no difference in the initial Hb levels between hydropic and non-hydropic fetuses that were treated before 22 weeks of gestation 17 . Hydrops rarely appears before 17 weeks of gestation, probably because of the immaturity of the reticuloendothelial system 4 .…”

“…Owing to concerns that intravascular transfusion might lead to circulatory overload and cardiac decompensation in the early stages of pregnancy, Poissonnier et al used a different approach and managed these early severe cases by performing intravenous fetal exchange transfusion. Their series included 32 affected fetuses treated before 22 weeks of gestation, resulting in a perinatal survival rate of 78% 17 .…”

“…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).…”

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].…”

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

“…However, IUT is not always possible and is potentially associated with morbidity and mortality, especially if performed before 20 weeks of gestation or in the presence of fetal hydrops [17,20,21,22,23,24,25,26]. Overall, procedure-related complications and fetal loss rates are 1.2-4.9% and 0.6-1.6% per procedure, respectively [20,27,28].…”