Early Intrauterine Transfusion in Fetuses with Severe Anemia Caused by Parvovirus B19 Infection

Abstract

Objective: To describe procedure-related complications and perinatal survival after intrauterine transfusion (IUT) before 20 weeks of gestation in fetuses with severe anemia due to human parvovirus B19 infection. Materials and Methods: A retrospective study was conducted of all fetuses requiring IUT before 20 weeks of gestation in two tertiary referral centers between January 2002 and July 2015. Gestational age (GA) at first IUT, fetal blood sampling results, and presence of hydrops were related to procedure-related complications, fetal death (FD), and perinatal outcome. Results: A total of 93 IUTs was performed on 55 fetuses. The mean GA at first IUT was 16⁺⁶ (13⁺⁰-19⁺⁶) weeks. FD occurred in 11 (20.0%) of the 55 fetuses. Overall survival was 80.0% (44/55). Hydrops was present in 38.2% (21/55) and was strongly associated with FD (p = 0.001). There was no difference with regard to FD, hydrops, or hemoglobin concentration at first IUT in fetuses with transfusion before or after 16⁺⁰ weeks. Conclusion: Severe anemia due to parvovirus B19 infection in the early second trimester can be treated successfully by IUT before 20 weeks of gestation in specialized centers with sufficient expertise.

Outcome of fetuses with congenital parvovirus B19 infection: systematic review and meta‐analysis

“…Of the 896 articles identified through the search, 87 were assessed for their eligibility (Table S2) and 35 studies were eventually included in the systematic review (Figure and Table ). These 35 studies included 611 fetuses affected by PB19 infection based on serological or virological confirmation or presence of signs of fetal anemia, such as hydrops, on ultrasound in fetuses with infected mothers. The definition of fetal hydrops in each included study is reported in Table S3.…”

Identification and management of congenital parvovirus B19 infection

“…IUT <20 weeks gestation is possible via the intravascular or intraperitoneal routes and has been performed as early as first trimester. 52,53 The commencement of intensive surveillance for fetal infection will be tailored to the gestation at which the fetal centre is able to offer fetal intervention with IUT.…”

“…The earliest gestation at which an IUT can be offered will be dependent on the expertise and facilities of the treating centre, as well as individual clinical factors such as placental location and technical access. IUT <20 weeks gestation is possible via the intravascular or intraperitoneal routes and has been performed as early as first trimester 52,53 . The commencement of intensive surveillance for fetal infection will be tailored to the gestation at which the fetal centre is able to offer fetal intervention with IUT.…”

Early Intraperitoneal Transfusion for Fetal Hydrops Caused by Parvovirus B19 Infection

“…We read with interest the article by Hellmund et al [1] describing procedurerelated complications and perinatal survival after intrauterine transfusion (IUT) before 20 weeks of gestation in fetuses with severe anemia due to human parvovirus B19 infection. In their cohort, intraperitoneal transfusion was only used in nonhydropic fetuses.…”