title: Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.
abstract: OBJECTIVE
  To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation.
  
  
  METHODS
  National referral center for intrauterine treatment of red-cell alloimmunization in The Netherlands.
  
  
  METHODS
  Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs. We compared fetal and neonatal outcome in three groups: fetuses only treated before 32 weeks gestation (group A, n=46), those treated both before and after 32 weeks (group B, n=117), and those where IUT was started at or after 32 weeks (group C, n=46).
  
  
  RESULTS
  Survival rate was 48% in group A, 100% in group B, and 91% in group C. Moreover, fetuses in group A were hydropic significantly more often. Short-term perinatal loss rate after IUT was 3.4% in the 409 procedures performed before 32 weeks and 1.0% in the 200 procedures performed after 32 weeks gestation.
  
  
  CONCLUSIONS
  Perinatal losses were much more common in fetuses only treated before 32 weeks gestation. Two procedure-related perinatal losses in 200 IUT after 32 weeks remain a matter of concern because of the good prospects of alternative extrauterine treatment.
authors.affiliation: Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. f.j.c.m.klumper@kgc.azl.nl
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.forename: I L
authors.initials: IL
authors.lastname: van Kamp
authors.forename: F P
authors.initials: FP
authors.lastname: Vandenbussche
authors.forename: R H
authors.initials: RH
authors.lastname: Meerman
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.forename: S A
authors.initials: SA
authors.lastname: Scherjon
authors.forename: P H
authors.initials: PH
authors.lastname: Eilers
authors.forename: H H
authors.initials: HH
authors.lastname: Kanhai
mesh_terms: D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects; D002585:Cesarean Section; D004899:Erythroblastosis, Fetal / Q000401:mortality / Q000628:therapy*; D005260:Female; D005313:Fetal Death; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome