title: Increased perinatal loss after intrauterine transfusion for alloimmune anaemia before 20 weeks of gestation.
abstract: OBJECTIVE
  To evaluate and compare perinatal outcome after intrauterine transfusions (IUT) performed before and after 20 weeks of gestation. To analyse contributing factors.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  The Dutch referral centre for fetal therapy.
  
  
  METHODS
  IUTs for fetal alloimmune anaemia.
  
  
  METHODS
  Fetuses were divided into two groups: fetuses requiring the first IUT before 20 weeks of gestation (Group 1) and those in which the IUTs started after 20 weeks (Group 2). The cause of perinatal loss was classified as procedure-related (PR) or not procedure-related (NPR). The cohort was divided into two periods to describe the change of perinatal loss over time.
  
  
  METHODS
  Perinatal loss of fetuses requiring the first IUT before 20 weeks of gestation, compared with perinatal loss later in gestation.
  
  
  RESULTS
  A total of 1422 IUTs were performed in 491 fetuses. Perinatal loss rate in Group 1 was higher (7/29 24% versus 35/462 8%, P = 0.002). Especially NPR was higher for IUTs performed before 20 weeks (4/37 11% versus 19/1385 1%, P < 0.001). Kell alloimmunisation was overrepresented in Group 1 (7/29 24% versus 52/462 11%, P = 0.04). In a multivariate regression analysis, only hydrops was independently associated with perinatal loss (P = 0.001). In recent years, a decline in total perinatal loss was found (36/224 16% versus 6/267 2%, P < 0.001), but perinatal loss in Group 1 did not decline (4/224 1.8% versus 3/267 1.1%, P = 0.5).
  
  
  CONCLUSIONS
  Perinatal loss after IUT performed before 20 weeks of gestation is increased compared with loss after IUT performed later in gestation. In addition, we confirmed earlier observations that hydrops is a major contributor to adverse outcome. Early and timely detection and treatment may prevent hydrops and improve outcome.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands. i.t.m.lindenburg@lumc.nl
authors.forename: I T M
authors.initials: IT
authors.lastname: Lindenburg
authors.forename: I L
authors.initials: IL
authors.lastname: van Kamp
authors.forename: E W
authors.initials: EW
authors.lastname: van Zwet
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.forename: F J C M
authors.initials: FJ
authors.lastname: Klumper
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
mesh_terms: D000743:Anemia, Hemolytic / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D001805:Blood Transfusion, Intrauterine / Q000401:mortality*; D004899:Erythroblastosis, Fetal / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D005260:Female; D046689:Fetal Mortality; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D054238:Perinatal Mortality; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate