Direct fetal intravenous immunoglobulin infusion as an adjunct to intrauterine fetal blood transfusion in rhesus-allommunized pregnancies: a pilot study.
OBJECTIVE
To study the usefulness of direct fetal intravenous immunoglobulin (IVIG) infusion along with intrauterine transfusion (IUT) in the management of severe fetal anemia in rhesus (Rh) alloimmunized pregnancies.


METHODS
Thirty-four consecutive Rh-isoimmunized pregnant women who required serial IUTs received either blood alone (control group, n = 16) or IVIG and blood (study group, n = 18). Pregnancies were followed up to delivery, and fetal outcome was recorded. The rate of fall of hematocrit was measured and compared between the two groups.


RESULTS
There was a slower rate of fall of hematocrit in the study group (IUT and IVIG) compared to the control group (only IUT). The mean rate of fall was 0.72 ± 0.54% per day in the study group while it was 1.29 ± 0.95% per day in the control group (p = 0.005).


CONCLUSIONS
Fall of fetal hematocrit was reduced in the study group. The results of this pilot study can be used to time the next transfusion in patients receiving IVIG along with IUT (taking the rate of fall as 0.70%). This may eventually result in decreasing the number of transfusions per fetus.
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
Deepika
D
Deka
K Aparna
KA
Sharma
Vatsla
V
Dadhwal
Aprajita
A
Singh
Guresh
G
Kumar
P
P
Vanamail
D000328:Adult; D000740:Anemia / Q000628:therapy*; D001805:Blood Transfusion, Intrauterine; D005260:Female; D005315:Fetal Diseases / Q000628:therapy; D046128:Fetal Therapies; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D010865:Pilot Projects; D011247:Pregnancy; D011446:Prospective Studies; D012203:Rh Isoimmunization / Q000628:therapy*
D016756:Immunoglobulins, Intravenous