[Blood group immunization: results of treatment of fetal anemia with intra-uterine intravascular blood transfusion in the Netherlands, 1987-1995].
OBJECTIVE
To evaluate outcome of red cell alloimmunized pregnancies treated with intravascular intrauterine blood transfusions.


METHODS
Retrospective.


METHODS
Medical records of all women and neonates treated with intrauterine transfusions in the period March 1987-December 1995, were reviewed. Survival rates of the infants were analysed in relation to both gestational age and the presence or absence of hydrops at the time of the first transfusion.


RESULTS
In 153 pregnancies 155 foetuses underwent 462 transfusions (median: 3; range: 1-7). Patients were immunized against RhD in 88%. Kell in 7% and Rhe in 5% of the cases. Overall survival rate was 83%. No difference in survival rate was found between children with the first transfusion early (< or = 26 weeks) or late (> 26 weeks) in pregnancy. Survival rate for foetuses without hydrops was significantly higher than for those with hydrops (90% versus 73%). The mildly hydropic foetuses had a significantly higher survival rate than the severely hydropic foetuses (94% versus 53%). Absence of intrauterine reversal of hydrops was associated with a bad outcome.


CONCLUSIONS
Intravascular transfusion is an effective and safe procedure for correction of foetal anaemia provided it is performed by an experienced multidisciplinary team. In contrast to gestational age at first transfusion severity of hydrops is predictive for successful treatment, so timely institution of treatment is of paramount importance.
van Kamp
I L
IL
Afd. Verloskunde, Leids Universitair Medisch Centrum, Leiden.
Klumper
F J
FJ
Meerman
R H
RH
Brand
A
A
Bennebroek Gravenhorst
J
J
Kanhai
H H
HH
D001789:Blood Group Antigens / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000453:epidemiology / Q000276:immunology; D001805:Blood Transfusion, Intrauterine / Q000401:mortality / Q000706:statistics & numerical data*; D004899:Erythroblastosis, Fetal / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000150:complications / Q000517:prevention & control*; D007231:Infant, Newborn; D007518:Isoantibodies / Q000097:blood*; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
D001789:Blood Group Antigens; D007518:Isoantibodies