Procedure-related complications and perinatal outcome after intrauterine transfusions in red cell alloimmunization in Stockholm.
BACKGROUND
We present a review of all cases of intravascular transfusions in red cell alloimmunization over a time span of 20 years in Stockholm. The aim of the study is to compare our results with published results from larger centers and to identify areas that can be further improved.


METHODS
A retrospective cohort study was conducted of all women treated with intrauterine transfusions due to erythrocyte immunization in our hospital between June 1990 and June 2010. Primary outcome variables were fetal and neonatal survival, procedure-related complications and gestational age at delivery.


RESULTS
A total of 284 intrauterine transfusions were performed in 84 pregnancies, with an overall survival rate of 91.8%. Procedure-related and fatal complications occurred in the present study in 4.9 and 1.4% of fetuses or neonates, respectively. Procedure-related complications were significantly more common in free-loop transfusions than in transfusions in the intrahepatic part of the umbilical vein (OR: 5.4, p = 0.025). There was no significant difference between the intrahepatic and the placental cord insertion route (p = 0.83). Gestational age at first transfusion was significantly associated with an increased risk of a procedure-related complication (OR: 0.8, p = 0.019). Of the live-born infants, 24% of the neonates were born before gestational week 34.


CONCLUSIONS
Our study confirms previous studies demonstrating favorable results with intravascular transfusions.
Center for Fetal Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden. eleonor.tiblad@karolinska.se
Eleonor
E
Tiblad
Marius
M
Kublickas
Gunilla
G
Ajne
The Hung
TH
Bui
Sverker
S
Ek
Anita
A
Karlsson
Agneta
A
Wikman
Magnus
M
Westgren
D000740:Anemia / Q000150:complications / Q000276:immunology / Q000628:therapy; D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects* / Q000379:methods; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D005315:Fetal Diseases / Q000097:blood / Q000276:immunology / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden