Techniques of intrauterine fetal transfusion for women with red-cell isoimmunisation for improving health outcomes.
BACKGROUND
Red-cell alloimmunisation can occur when there are incompatibilities between a woman's blood type and that of her unborn baby. This can cause the baby to become anaemic (low red blood cell count), which may require treatment during the pregnancy by blood transfusion while the baby remains within the uterus (called an intrauterine blood transfusion).


OBJECTIVE
To compare, using the best available evidence, the benefits and harms of different techniques of intrauterine fetal blood transfusion for women with red-cell alloimmunisation.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010).


METHODS
We considered randomised controlled trials comparing different techniques of intrauterine fetal blood transfusion (either alone or in combination with another technique) for inclusion.


METHODS
Two authors evaluated trials under consideration for appropriateness for inclusion and methodological quality, without consideration of their results according to the prestated eligibility criteria. We planned to use a fixed-effect meta-analysis for combining study data if we judged the trials to be sufficiently similar. We planned to investigate statistical heterogeneity using the I(2) statistic; if this indicated a high degree of statistical heterogeneity, we planned to use a random-effects model.


RESULTS
Our search strategy identified four reports of three studies for consideration, of which two met the inclusion criteria, involving 44 women. We identified a single trial comparing the use of intrauterine fetal blood transfusion and intravenous immunoglobulin versus intrauterine fetal blood transfusion alone, and a single trial comparing the use of atracurium and pancuronium. There were no statistically significant differences identified for any of the reported outcomes.


CONCLUSIONS
There is little available high quality information from randomised controlled trials to inform the optimal procedural technique when performing fetal intrauterine fetal blood transfusions for women with an anaemic fetus due to red cell alloimmunisation. Further research evaluating the benefits and harms associated with different techniques is required.
Dodd
Jodie M
JM
School of Paediatrics and Reproductive Health, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 72 King William Road, Adelaide, South Australia, Australia, 5006.
Windrim
Rory C
RC
van Kamp
Inge L
IL
D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012203:Rh Isoimmunization / Q000628:therapy*; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous