title: Is intrauterine exchange transfusion a safe procedure for management of fetal anaemia?
abstract: OBJECTIVE
  To study modalities and complications of intrauterine exchange transfusion (IUET) for the management of severe fetal anaemia.
  
  
  METHODS
  Retrospective study of all IUET procedures performed between January 1999 and January 2012 at a regional centre. Characteristics of each procedure were studied to identify risk factors for complications. Survival rates according to the different aetiologies of anaemia were evaluated.
  
  
  RESULTS
  In total, 225 IUET procedures were performed in 96 fetuses. Major indications were feto-maternal erythrocyte alloimmunization (n=80/96, 83.3%) and parvovirus B19 infection (n=13/96, 13.5%). Twenty-six percent of the fetuses (25/96) had hydrops fetalis before the first IUET. Intrauterine fetal death occurred after 2.7% (6/225) of procedures, premature rupture of the membranes occurred after 0.9% (2/225) of procedures, and emergency caesarean section was required after 3.6% (8/225) of procedures. Fetal bradycardia [odds ratio (OR) 37, 95% confidence interval (CI) 8.3-170; p<0.01] and gestational age up to 32 weeks (OR 3.67; 95% CI, 1.07-12.58; p=0.038] were significantly associated with complications after IUET. Complications occurred in 17.7% of pregnancies (17/96) and 7.5% of IUET procedures (17/225). The overall survival rate in the study cohort was 87.5% (84/96): 90% (72/80) in the alloimmunization group and 76.9% (10/13) in the parvovirus-infected group (NS).
  
  
  CONCLUSIONS
  IUET has a higher complication rate than simple intrauterine transfusion, and should be performed by well-trained specialists.
authors: Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France. Electronic address: charles.garabedian@gmail.com.
authors: C
authors: C
authors: Garabedian
authors: Department of Obstetrics and Gynecology, Roubaix Hospital Center, France.
authors: M
authors: M
authors: Philippe
authors: Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France.
authors: P
authors: P
authors: Vaast
authors: Institute of Hematology and Transfusion, Jeanne de Flandre Hospital, CHRU Lille, France.
authors: B
authors: B
authors: Wibaut
authors: Department of biostatistics, EA2694, UDSL, University of Lille North of France, CHRU Lille, France.
authors: J
authors: J
authors: Salleron
authors: Etablissement français du Sang, Nord Pas de Calais, France.
authors: A
authors: A
authors: Delsalle
authors: Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France.
authors: T
authors: T
authors: Rakza
authors: Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France; University of Lille North of France, France.
authors: D
authors: D
authors: Subtil
authors: Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France; University of Lille North of France, France.
authors: V
authors: V
authors: Houfflin-Debarge
mesh_terms: D000740:Anemia / Q000401:mortality / Q000628:therapy*; D001805:Blood Transfusion, Intrauterine / Q000379:methods* / Q000401:mortality; D005078:Exchange Transfusion, Whole Blood / Q000379:methods* / Q000401:mortality; D005260:Female; D005315:Fetal Diseases / Q000401:mortality / Q000628:therapy*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Erythrocyte alloimmunization; Fetal therapy; Hydrops fetalis; Intrauterine exchange transfusion; Parvovirus B19