Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.
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.
Klumper
F J
FJ
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
van Kamp
I L
IL
Vandenbussche
F P
FP
Meerman
R H
RH
Oepkes
D
D
Scherjon
S A
SA
Eilers
P H
PH
Kanhai
H H
HH
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