Perinatal survival and procedure-related complications after intrauterine transfusion for red cell alloimmunization.
OBJECTIVE
To study the perinatal survival and procedure-related (PR)complications after intrauterine transfusions in red cell alloimmunization.


METHODS
Prospective data of 102 women with Rh-alloimmunized pregnancy undergoing intrauterine intravascular transfusion for fetal anemia, from January 2011 to October 2014 were analyzed. Main outcome measures were perinatal survival and procedure-related (PR) complications.


RESULTS
A total of 303 intrauterine transfusions were performed in 102 women. Of 102 fetuses, 22 were hydropic at first transfusion. The mean period of gestation and hematocrit at first transfusion was 26.9 ± 3.3 weeks (range 19.7-33.8 weeks) and 17 ± 7.82 % (range 5.7-30 %), respectively. Average number of transfusions was 2.97 (range 1-7) per patient. Overall survival was 93 % and mean period of gestation at delivery was 34.5 ± 1.94 (range 28.3-37.4) weeks. Mean hematocrit at delivery was 36.9 ± 8.77 % (range 10-66 %). Fetal death occurred in four cases (3PR), neonatal death occurred in three cases (2PR). Emergency cesarean delivery after transfusion was performed in four pregnancies. The total PR complication rate was 2.97 %, resulting in overall PR loss in 1.65 % per procedure.


CONCLUSIONS
Our results compare favorably with other studies published in the literature. Intravascular transfusion is a safe procedure improving perinatal survival in fetuses with anemia due to Rh-alloimmunization.
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Dipika
D
Deka
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. vatslad@hotmail.com.
Vatsla
V
Dadhwal
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Aparna K
AK
Sharma
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Unnati
U
Shende
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Sumita
S
Agarwal
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Ramesh
R
Agarwal
Department of Obstetrics and Gynecology and Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Perumal
P
Vanamail
D000328:Adult; D001805:Blood Transfusion, Intrauterine / Q000009:adverse effects*; D004899:Erythroblastosis, Fetal / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D017063:Outcome Assessment, Health Care; D066087:Perinatal Death; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000628:therapy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D016019:Survival Analysis
Fetal anemia; Fetal therapy; Intrauterine transfusion; Red blood cell alloimunization