The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment

A new method to determine the feto-placental volume based on dilution of fetal haemoglobin and an estimation of plasma fluid loss after intrauterine intravascular transfusion

“…The fetuses received these transfusions between 19 and 36 weeks of gestation. At the start of the intrauterine treatment, eight fetuses were classified as mildly hydropic and seven as severely hydropic and 27 as non-hydropic 11 . Fetal anaemia was caused by antiRhesus D antibodies (n ¼ 33), and anti-Kell antibodies (n ¼ 7).…”

Intrauterine Blood Transfusion: Current Indications and Associated Risks

“…In the literature, procedure-related fetal loss ranges from 0.9 to 4.9% per procedure [7,50,51,52,53,54] and was found to be associated with fetal hydrops [54,55], early gestational age [50,51], failing to use fetal paralysis during IUT [7], transfusion at a free loop of cord or arterial puncture [7,52], experience of the operator [52,56] and severity of fetal anemia [53]. Interestingly, preterm premature rupture of membranes after transfusion appears extremely rare, e.g.…”

Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

“…In pregnancies with red cell alloimmunization, obstetric history and maternal antibody titers should be carefully evaluated to identify fetuses at risk for anemia. The challenge is to transfuse in case of moderate to severe anemia but before the fetus develops hydrops, which is associated with low survival rates compared with non-hydropic fetuses [81] . Hydrops is characterized by generalized skin edema and fl uid collection in more than one area, such as pericardial, pleural, or ascitic effusions.…”

“…It develops when the Hgb defi cit is > 6 SD below the mean for gestational age (i.e., Hct 15 % , Hgb 5 g/dL) [55] , whereas a transfusion is performed when the fetal Hgb level is 4 -6 SD below the mean gestational age, which corresponds to an Hgb defi cit of more than 6 g/dL. Hydropic signs will normally reverse after one or two transfusions, but the reversal rate depends on the severity of the disease (88 % in fetuses with mild hydrops and 39 % in fetuses with severe hydrops) [81] . The precise method of assessing the severity of fetal anemia is by fetal blood sampling, but cordocentesis carries a risk of infection, bleeding, fetal bradycardia, and procedurerelated fetal loss of 1 % and should be undertaken only if there is strong evidence that the fetus is severely affected [3] .…”