Intrauterine Blood Transfusion: Current Indications and Associated Risks

Lindenburg, Irene T.M.; Kamp, Inge L. van; Oepkes, Dick

doi:10.1159/000362812

Cited by 143 publications

(91 citation statements)

References 74 publications

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“…IUT is a well-established method to correct fetal anemia and prolong gestation until a more mature gestational age is reached [17]. Our review confirms that the management strategy of IUTs for FMH resulted in significant gains in gestational age, although multiple transfusions were typically needed.…”

Section: Discussionsupporting

confidence: 69%

“…After 32 weeks, the risk of complications of intrauterine transfusion (IUT) should be balanced with the risk of prematurity and/or neonatal transfusion [16]. When FMH occurs before 32 weeks, IUT is a well-established procedure to treat fetal anemia [17], but it is still unclear what is the proper monitoring of these pregnancies after the first IUT and what is the recurrence rate. The objective of our study was to determine the recurrence rate of FMH after IUT in order to understand the natural history of FMH and therefore improve fetal outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Recurrence Risk of Fetomaternal Hemorrhage

et al. 2018

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Massive fetomaternal hemorrhage (FMH) can cause devastating pregnancy outcomes. Perinatal prognosis may be improved by intrauterine transfusion, but the appropriate management for these pregnancies remains unclear. To determine the recurrence risk of FMH after intrauterine transfusion, we performed a systematic review of all case reports/series of patients with proven FMH treated with intrauterine transfusion and who had subsequent follow-up of at least 72 h until delivery. This revealed 13 cases, with 1 additional case from our institution. Ten patients (71.4%) had a second episode of FMH requiring a second intrauterine transfusion. Five patients (35.7%) required at least 3 intrauterine transfusions. The time interval between intrauterine transfusions was progressively reduced. The gestational age at the onset of signs/symptoms was 26.6 ± 2.1 weeks, and gestational age at delivery was 34.2 ± 4.2 weeks. Two cases of fetal demise (14.3%) and no neonatal deaths were recorded. Limited postnatal follow-up on 8 neonates was normal. The mean neonatal hemoglobin and transfusion rates were 13.2 ± 5.7 g/dL and 33.3%, respectively. Close fetal monitoring, likely daily, is necessary to recognize FMH recurrence. Several transfusions may be necessary once FMH is diagnosed if pregnancy is allowed to continue > 72 h.

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Section: Discussionsupporting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

The Recurrence Risk of Fetomaternal Hemorrhage

et al. 2018

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“…In contrast to a number of studies reporting the outcome of IUTs in red blood cell alloimmunization [8][9][10], data on intrauterine treatment of parvovirus B19-related anemia are limited [1,6,11,12]. While the majority of transfusions in red blood cell alloimmunization are performed beyond 20 weeks, parvovirus B19 often affects fetuses in the early second trimester.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Currently, the survival rate for alloimmunization to RBCs exceeds 80% in specialized centers all over the world [17,18,19]. However, IUT is not always possible and is potentially associated with morbidity and mortality, especially if performed before 20 weeks of gestation or in the presence of fetal hydrops [17,20,21,22,23,24,25,26].…”

Section: Introductionmentioning

confidence: 99%

“…However, IUT is not always possible and is potentially associated with morbidity and mortality, especially if performed before 20 weeks of gestation or in the presence of fetal hydrops [17,20,21,22,23,24,25,26]. Overall, procedure-related complications and fetal loss rates are 1.2-4.9% and 0.6-1.6% per procedure, respectively [20,27,28].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

Mayer

Hinkson

Hillebrand

et al. 2018

Transfus Med Hemother

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Background: Alloimmunization to red blood cells (RBCs) may result in fetal anemia prior to 20 weeks gestation. The question as to whether early commencement of antenatal treatment with high-dose intravenous immunoglobulins (IVIG) may prevent or at least delay the development of fetal anemia in the presence of alloantibodies to RBCs is highly relevant. Patients and Results: Here we describe a patient with high-titer anti-K and two other severely affected pregnant women with a history of recurrent pregnancy loss due to high-titer anti-D or anti-D plus anti-C. Early commencement of treatment with IVIG (1 g/kg/week) resulted in prevention of intrauterine transfusion (IUT) in the former two cases, and in a significant delay of development of fetal anemia in the remaining case (26 weeks gestation). Conclusion: Based on our findings and of previously published cases, early initiation of treatment of severely alloimmunized women with IVIG (1 g/kg/week) could potentially improve the outcome of fetuses at risk.

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Intrauterine Blood Transfusion: Current Indications and Associated Risks

Cited by 143 publications

References 74 publications

The Recurrence Risk of Fetomaternal Hemorrhage

The Recurrence Risk of Fetomaternal Hemorrhage

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

Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells

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