title: Fetal Intracardiac Transfusions in Hydropic Fetuses with Severe Anemia.
abstract: BACKGROUND
  Fetal anemia can have significant perinatal morbidity and mortality, particularly with onset prior to 20 weeks of gestation.
  
  
  METHODS
  We detail a case-cohort study (n = 8) of all women who underwent fetal in-utero, intracardiac transfusion prior to 24 weeks of gestation (7 women before 20 + 1 weeks), between March 2004 and September 2014, in a supraregional Fetal Medicine Center in the United Kingdom, comprising 2.2% of all transfusions performed during this period. All the fetuses were hydropic, with high maternal BMI, and had severe anemia as an indicator for transfusion. It was an attempt to perform intravascular transfusion when other common routes of fetal vascular access had failed.
  
  
  RESULTS
  There were 2 intrauterine deaths (25%), both of which were associated with in-utero transfusion and fulminant parvovirus B19 infection. The perinatal survival rate was 75% (6/8).
  
  
  CONCLUSIONS
  Fetal in-utero, intravascular transfusion by the intracardiac route may be used to correct severe early-onset anemia. It is particularly useful when technical issues of fetal size, early gestation (<20 weeks), maternal adiposity, and hydrops fetalis make umbilical cord or intrahepatic vein puncture technically difficult. Survival rates appear comparable to other series of pregnancies where in-utero transfusion is performed at early gestation.
authors: Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham, UK.
authors: Fiona L
authors: FL
authors: Mackie
authors: Samantha J
authors: SJ
authors: Pretlove
authors: William L
authors: WL
authors: Martin
authors: Veronica
authors: V
authors: Donovan
authors: Mark D
authors: MD
authors: Kilby
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications / Q000628:therapy* / Q000821:virology; D001805:Blood Transfusion, Intrauterine / Q000379:methods*; D015331:Cohort Studies; D016731:Erythema Infectiosum / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D015160:Hydrops Fetalis / Q000628:therapy*; D017992:Parvovirus; D011247:Pregnancy; D016896:Treatment Outcome