title: Neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed with intrauterine transfusion: a service evaluation.
abstract: BACKGROUND
  This study, conducted in the tertiary Foetal Medicine Unit at St Michael's Hospital, Bristol, was designed to obtain information regarding neonatal outcomes of pregnancies affected by haemolytic disease of the foetus and newborn and managed by intrauterine transfusion, and to determine whether a change in intrauterine transfusion protocol in 2004 had improved safety. The new protocol included attendance of two Foetal Medicine Unit consultants, foetal sedation and use of the intrahepatic vein as an alternative route to placental cord insertion if deemed safer.
  
  
  METHODS
  Data for pregnancies affected by haemolytic disease of the foetus and newborn as a result of haemolytic red cell alloimmunisation and managed with intrauterine transfusion at St Michael's Hospital between 1999 and 2009 were retrospectively collected using local databases, and medical note review.
  
  
  RESULTS
  Overall, 256 relevant intrauterine transfusions were performed. The median number of intrauterine transfusions per pregnancy was two. Ninety-three per cent of the live deliveries had 5-minute APGAR scores ≥9 and 98% were admitted to a Neonatal Intensive Care Unit/Special Care Baby Unit, requiring phototherapy (96%), top-up transfusions (44%: 23.2% immediate, 13.4% late, 7.3% both), and exchange transfusion (37%). An association was found between increased intrauterine transfusion number and reduced phototherapy duration and hospital admission: each additional intrauterine transfusion reduced the duration of phototherapy by 16% (95% CI: 0.72-0.98), and Neonatal Intensive Care Unit/Special Care Baby Unit admission by 44% (95% CI: 0.48-0.66). Following the change in intrauterine transfusion protocol, there was a significant reduction in the number of emergency Caesarean sections occurring directly after an intrauterine transfusion (n =5 vs 0; P =0.02). The foetal loss rate within 48 hours of an intrauterine transfusion was 1.9% per pregnancy, or 0.8% per intrauterine transfusion: no losses occurred under the new protocol (n =3 vs 0; P = NS).
  
  
  CONCLUSIONS
  Although the majority of neonates required admission to a Neonatal Intensive Care Unit/Special Care Baby Unit and phototherapy, the medium-term outcomes were positive. Importantly, the safety of the intrauterine transfusion procedure has improved significantly since the change in protocol.
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Birchenall
authors.affiliation: Foetal Medicine Unit, Department of Obstetrics and Gynaecology, University of the Andes, San Carlos de Apoquindo, Santiago, Chile.
authors.forename: Sebastian E
authors.initials: SE
authors.lastname: Illanes
authors.affiliation: Foetal Medicine Unit, Department of Obstetrics and Gynaecology, University of the Andes, San Carlos de Apoquindo, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Overton
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Liebling
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Soothill
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Sherif
authors.initials: S
authors.lastname: Abdel-Fattah
authors.affiliation: Foetal Medicine Unit, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Denbow
mesh_terms: D000328:Adult; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D016208:Databases, Factual; D004899:Erythroblastosis, Fetal / Q000628:therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D006113:United Kingdom