Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization.
OBJECTIVE
The purpose of this study was to establish the true procedure-related complication rate of intrauterine transfusion therapy.


METHODS
A cohort study of 254 fetuses treated with 740 intrauterine blood transfusions for red-cell alloimmunization in a single center in the years 1988 to 2001. Our database was searched for perinatal deaths, emergency deliveries, infections, and preterm rupture of membranes associated with intrauterine blood transfusion. Complications were categorized by two independent obstetricians as procedure-related (PR) or not procedure-related (NPR). Logistic regression analysis was used to identify risk factors for complications.


RESULTS
Overall survival was 225/254 (89%). Fetal death occurred in 19 cases (7 PR) and neonatal death in 10 cases (5 PR). There were two cases of intrauterine infection with Escherichia coli (both PR) and two other cases of preterm premature rupture of membranes (1 PR) within a week of a procedure. Emergency delivery after a transfusion was performed in 18 pregnancies (15 PR). The total PR complication rate was 3.1%, resulting in an overall PR loss rate of 1.6% per procedure. Arterial puncture, transamniotic cord puncture, refraining from fetal paralysis, and advancing gestational age were associated with the occurrence of PR complications.


CONCLUSIONS
Our study shows that intrauterine transfusion is a safe procedure, with a relatively low PR perinatal loss rate. Arterial puncture and transamniotic cord needling carry a high risk for serious complications, whereas fetal paralysis improves the safety of the procedure. This information on risks of intrauterine transfusion therapy may help to further improve the safety of intrauterine transfusions. Data on complication rates of intrauterine transfusions are essential in counseling patients.
Van Kamp
Inge L
IL
Department of Obstetrics, Fetal Medicne Unit, Leiden University Medical Center, The Netherlands. i.l.van_kamp@lumc.nl
Klumper
Frans J C M
FJ
Oepkes
Dick
D
Meerman
Robertjan H
RH
Scherjon
Sicco A
SA
Vandenbussche
Frank P H A
FP
Kanhai
Humphrey H H
HH
D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects* / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D004899:Erythroblastosis, Fetal / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D009426:Netherlands / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D012449:Safety; D016019:Survival Analysis