An audit of outcome in intravascular transfusions using the intrahepatic portion of the fetal umbilical vein compared to cordocentesis.
BACKGROUND
Maternal red cell alloimmunization is a potential cause of perinatal morbidity and mortality. The outcome of severe disease has been transformed by the use of in-utero and particularly, fetal intravascular transfusion. In the majority of instances this is performed by cordocentesis. However, this cohort study represents the experience in a large tertiary referral centre in performing fetal intravascular transfusions via the intrahepatic vein (IHV).


METHODS
Over an 8-year period, 1997-2004, 221 in-utero transfusions (IUT) were performed for rhesus disease in 66 pregnancies. 86% had severe fetal anaemia caused by anti-D, 10.6% by anti-Kell and 3.4% by anti-c. The median maternal age of the cohort was 31 years (range 19-43). The median gestation at initial IUT was 25 weeks (interquartile range (IQR) 23-29 weeks).


RESULTS
A median number of three IUT were performed in each fetus (IQR 2-5) with a median haemoglobin at first fetal blood sampling of 7.3 g% (IQR 4.6-8.8 g%) (73% < or =5 SD and 27% < or =2 SD). Of the total intravascular transfusions, 170 were performed via the IHV (71.7%), 33 via cordocentesis (13.9%) and 1 by intracardiac puncture (0.5%). There were 'transient' bradycardias complicating 4.1% of all transfusions and amniorrhexis following 1.4%. 92% of babies were live born at a median gestation of 34 weeks (range 21-38) with a birth weight centile of 50 (range 3-90). There was no significant difference in intravascular transfusion complication rate when the procedure was performed via the IHV (7.6%) as compared to cord root puncture (3.0%) (Fisher's exact test, p < 0.47).


CONCLUSIONS
IUT performed by fetal IHV puncture is safe and carries no excess morbidity when performed for severe rhesus disease.
Somerset
David A
DA
Department of Fetal Medicine, Division of Reproduction and Child Health, Birmingham Women's Hospital, University of Birmingham, UK.
Moore
Alison
A
Whittle
Martin J
MJ
Martin
William
W
Kilby
Mark D
MD
D000328:Adult; D000740:Anemia / Q000276:immunology / Q000628:therapy; D001787:Blood Group Incompatibility / Q000628:therapy*; D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects / Q000379:methods*; D017218:Cordocentesis; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005315:Fetal Diseases / Q000628:therapy; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000196:embryology; D008423:Maternal Age; D008485:Medical Audit; D011247:Pregnancy; D012203:Rh Isoimmunization / Q000628:therapy; D016896:Treatment Outcome; D014471:Umbilical Veins / Q000196:embryology*
D006454:Hemoglobins