Abstract
Objectives
To study the perinatal survival and procedure-related (PR)complications after intrauterine transfusions in red cell alloimmunization.
Methods
Prospective data of 102 women with Rh-alloimmunized pregnancy undergoing intrauterine intravascular transfusion for fetal anemia, from January 2011 to October 2014 were analyzed. Main outcome measures were perinatal survival and procedure-related (PR) complications.
Results
A total of 303 intrauterine transfusions were performed in 102 women. Of 102 fetuses, 22 were hydropic at first transfusion. The mean period of gestation and hematocrit at first transfusion was 26.9 ± 3.3 weeks (range 19.7–33.8 weeks) and 17 ± 7.82 % (range 5.7–30 %), respectively. Average number of transfusions was 2.97 (range 1–7) per patient. Overall survival was 93 % and mean period of gestation at delivery was 34.5 ± 1.94 (range 28.3–37.4) weeks. Mean hematocrit at delivery was 36.9 ± 8.77 % (range 10–66 %). Fetal death occurred in four cases (3PR), neonatal death occurred in three cases (2PR). Emergency cesarean delivery after transfusion was performed in four pregnancies. The total PR complication rate was 2.97 %, resulting in overall PR loss in 1.65 % per procedure.
Conclusion
Our results compare favorably with other studies published in the literature. Intravascular transfusion is a safe procedure improving perinatal survival in fetuses with anemia due to Rh-alloimmunization.
Similar content being viewed by others
References
Liley AW (1963) Intrauterine transfusion of fetus in hemolytic disease. Br Med J 2:1107–1109
Rodeck CH, Kemp JR, Holman CA, Whitmore DN, Karnicki J, Austin MA (1981) Direct intravascular fetal blood transfusion by fetoscopy in severe Rhesus isoimmunization. Lancet 1:625–627
Bang J, Bock JE, Trolle D (1982) Ultrasound guided fetal intravascular transfusion for severe rhesus hemolytic disease. Br Med J (Clin Res Ed) 284:373–374
Van Kamp IL, Klumper FJCM, Meerman RH, Oepkes D, Scherjon SA, Kanhai HHH (2004) Treatment of fetal anemia due to red-cell alloimmunization with intrauterine transfusions in the Netherlands, 1988–1999. Acta Obstet Gynecol Scand 83:731–737
Lindenburg I, van Kamp L, Oepkes D (2014) Intrauterine Blood Transfusion: current Indications and associated risks. Fetal Diagn Ther 36:263–271
Tiblad E, Kublickas M, Ajne G, Bui TH, Karlsson A, Wikman A, Westgren M (2011) Procedure related complications and perinatal outcome after intrauterine transfusions in red cell alloimmunization in Stockholm. Fetal Diagn Ther 30:266–273
Ayliffe-Johnstone C, Prior T, Ong C, Regan F, Kumar S (2012) Early procedure-related complications of fetal blood sampling and intrauterine transfusion of fetal anemia. Acta Obstet Gynecol Scand 91:458–462
Altunyurt S, Okyay E, Saatli B, Canbahishov T, Demir N, Ozkan H (2012) Neonatal outcome of fetuses receiving intrauterine transfusions for severe hydrops complicated by Rhesus hemolytic disease. Int J Gynecol Obstet 117:153–156
Dadhwal V, Deka D, Gurunath S, Mittal S, Paul VK, Deorari A (2010) Treatment of fetal anemia in rh isoimmunized pregnancies with intrauterine fetal blood transfusion. J Obstet Gynecol India 60(2):135–140
van Kamp IL, Klumper FJCM, Oepkes D, Meerman RH, Scherjon SA, Vandenbussche FPHA, Kanhai HHH (2005) Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol 192:171–177
Lindenburg I, van Kamp I, van Zwet E, Middeldorp J, Klumper E, Oepkes D (2013) Increased perinatal loss after intrauterine transfusion for alloimmune anemia before 20 weeks of gestation. BJOG 120:847–852
Van Kamp IL, Klumper FJ, Bakkum RS, Oepkes D, Meerman RH, Scherjon SA, Kanhao HH (2001) The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol 185:668–673
Yinon Y, Visser J, Kelly EN, Windrim R, Amsalem H, Seaward PG, Ryan G (2013) Early intrauterine transfusion in severe red blood cell alloimmunization. Ultrasound Obstet Gynecol 36:601–606
Lindenburg IT, Wolterbeek R, Oepkes D, Klumper FJ, Vandenbussche FP, van Kamp IL (2011) Quality control for intravascular transfusion using cumulative sum (CUSUM) analysis for the monitoring of individual performance. Fetal Diagn Ther 29:307–314
Osanan GC, Silveira Reis ZN, Apocalypse IG, Lopes AP, Pereira AK, da Silva Ribeiro OM, Vieira Cabral AC (2012) Predictive factors of perinatal mortality in transfused fetuses due to maternal alloimmunization:what really matters? J Matern Fetal Neonatal Med 25:1333–1337
Lindenburg IT, Smits-Wintjens VE, van Klink JM, Verduin E, van Kamp IL, Walther FJ, Schonewille H, Doxiadis II, Kanhai HH, van Lith JM, van Zwet EW, Oepkes D, Brand A, Lopriore E, LOTUS study group (2012) Long term neurodevelopment outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn: the LOTUS study. Am J Obstet Gynecol 206:141e1–141e8
Lindenburg IT, van Klink JM, Smits-Wintjens VE, van Kamp IL, Oepkes D, Lopriore E (2013) Long term neurodevelopment and cardiovascular outcome after intrauterine transfusion for fetal anemia: a review. Prenat Diagn 33:815–822
Smits-Wintjens VE, Rath ME, van Zwet EW, Oepkes D, Brand A, Walther FJ, Lopriore E (2013) Neonatal morbidity after exchange transfusion for red cell alloimmune hemolytic disease. Neonatology 103(2):141–147. doi:10.1159/000343261
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no conflicts of interest.
Author contribution
Deka D: Protocol/project development (Patient management protocols). Vatsla D: Protocol/project development, Data management, Manuscript writing. Sharma KA: Protocol/project development, Data collection and management. Shende U: Data collection. Agarwal S: Data Collection. Agarwal R: Protocol/project development (neonatal management). Perumal V: Data analysis.
Additional information
This research has not been sponsored by any organisation. The authors have full control of all primary data and that they would agree to allow the Journal to review their data if requested.
Rights and permissions
About this article
Cite this article
Deka, D., Dadhwal, V., Sharma, A.K. et al. Perinatal survival and procedure-related complications after intrauterine transfusion for red cell alloimmunization. Arch Gynecol Obstet 293, 967–973 (2016). https://doi.org/10.1007/s00404-015-3915-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3915-7