Advertisement
Poster session II Diabetes, labor, medical-surgical-disease, obstetric quality & safety, prematurity, ultrasound-imaging: Abstracts 237 – 386| Volume 206, ISSUE 1, SUPPLEMENT , S160, January 01, 2012

341: Fetal loss rates from intrauterine fetal transfusion: a prospective tertiary center study

      Objective

      To examine perinatal outcomes following intrauterine fetal red cell transfusion (IUT) in a single tertiary obstetric unit over a 15-year period.

      Study Design

      This is a prospective study of all IUTs performed at the National Maternity Hospital, Dublin, which is Irelands largest fetal medicine center. Eligible cases were identified from a prospectively collated hospital transfusion register; the clinical details for each case were extracted and recorded onto a computerized database. Women undergoing IUT for alloimmune thrombocytopenia, non-immune fetal hydrops or parvovirus infection were excluded. The cord insertion was the preferred site for IUT, with the intra-hepatic vein and free cord loop reserved for cases where the cord insertion was inaccessible.

      Results

      Between January 1996 and December 2010, 262 intrauterine transfusions were performed in our unit, of which 244 (93%) were undertaken for red cell alloimmunisation, involving 97 pregnancies. The majority of women (84%, 81/97) had anti-D antibodies, with a smaller incidence of anti-Kell (12%), anti-c (3%) and anti-E (1%) antibodies. Affected women underwent a median of 3 (IQR 2-4) IUT procedures. The median gestation at first IUT was 27 (IQR 25-31) weeks. In total, there were 3 intrauterine fetal deaths and 4 early neonatal deaths in this cohort, giving a perinatal mortality rate of 7% and a survival rate of 93%. There were 3 perinatal losses directly related to the transfusion (all in women with anti-D antibodies), giving an overall procedure-related loss rate of 1.2% (3/244) per procedure. Two women had in utero fetal demise within 48 hours of the IUT, at 25 weeks 29 weeks respectively. The third loss was early neonatal demise following emergency CS for fetal bradycardia due to cord hematoma at 32 weeks gestation.

      Conclusion

      Intrauterine fetal transfusion is a safe procedure, associated with a low (1.2%) rate of procedure-related fetal loss, when performed by experienced practitioners in a national referral center.