Research Article
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Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization

Year 2024, Volume: 41 Issue: 2, 324 - 326, 19.05.2024

Abstract

The aim of this study was to assess perinatal outcomes of intrauterine transfusions (IUT) which were performed for Rh alloimmunization. We retrospectively analyzed 109 consecutive intrauterine transfusions, which included 28 pregnancies and 29 fetuses (one dichorionic-diamniotic twin pregnancy) between 2017 and 2019, from the hospital records. The study cohort was compared by means of the presence of hydrops before the beginning of intrauterine transfusions, the severity of fetal anemia, and Doppler parameters before consecutive transfusions. We evaluated perinatal outcomes, which consisted of fetal complications due to intrauterine transfusions and neonatal outcomes. Before the first IUT, 48,3% of the fetuses had hydrops fetalis, and 82,8% had severe anemia. The highest number of IUTs for the same fetus was eight. Overall survival rate was 72%. We divided our cohort into two groups by means of the presence of hydrops fetalis upon first admission. We found that the fetal hemoglobin levels before the first IUT were significantly lower in the hydropic fetuses. Intrauterine transfusion is a safe and effective treatment even in high-risk populations.

References

  • Bowman JM. Controversies in Rh prophylaxis. Who needs Rh immune globulin and when should it be given? Am J Obstet Gynecol. 1985;151(3):289-94. Epub 1985/02/01. doi: 10.1016/0002-9378(85)90288-1. PubMed PMID: 2982267.
  • Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ, Jr., et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 2000;342(1):9-14. Epub 2000/01/06. doi: 10.1056/NEJM200001063420102. PubMed PMID: 10620643.
  • Urbaniak SJ, Greiss MA. RhD haemolytic disease of the fetus and the newborn. Blood Rev. 2000;14(1):44-61. Epub 2000/05/11. doi: 10.1054/blre.1999.0123. PubMed PMID: 10805260.
  • Savkli AO, Cetin BA, Acar Z, Ozkose Z, Behram M, Caypinar SS, et al. Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation. J Obstet Gynaecol. 2020;40(5):649-53. Epub 2019/08/30. doi: 10.1080/01443615.2019.1647521. PubMed PMID: 31462132.
  • Arslan E, Demir SC, Ozsurmeli M, Akcabay C. Perinatal outcomes and survival predictors of severe red-cell alloimmunization treated by intrauterine transfusion. J Obstet Gynaecol Res. 2021;47(8):2632-40. Epub 2021/05/22. doi: 10.1111/jog.14860. PubMed PMID: 34018269.
  • Nicolaides KH, Soothill PW, Clewell WH, Rodeck CH, Mibashan RS, Campbell S. Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet. 1988;1(8594):1073-5. Epub 1988/05/14. doi: 10.1016/s0140-6736(88)91896-x. PubMed PMID: 2452938.
  • Mandelbrot L, Daffos F, Forestier F, MacAleese J, Descombey D. Assessment of fetal blood volume for computer-assisted management of in utero transfusion. Fetal Ther. 1988;3(1-2):60-6. Epub 1988/01/01. doi: 10.1159/000263335. PubMed PMID: 3257068.
  • Ghesquiere L, Houfflin-Debarge V, Behal H, Coulon C, Subtil D, Vaast P, et al. Should optimal timing between two intrauterine transfusions be based on estimated daily decrease of hemoglobin or on measurement of fetal middle cerebral artery peak systolic velocity? Transfusion. 2017;57(4):899-904. Epub 2017/03/16. doi: 10.1111/trf.13980. PubMed PMID: 28295352.
  • Branger B, Winer N. [Epidemiology of anti-D allo-immunization during pregnancy]. J Gynecol Obstet Biol Reprod (Paris). 2006;35(1 Suppl):1S87-1S92. Epub 2006/02/24. PubMed PMID: 16495833.
  • Schumacher B, Moise KJ, Jr. Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstet Gynecol. 1996;88(1):137-50. Epub 1996/07/01. doi: 10.1016/0029-7844(96)00113-5. PubMed PMID: 8684747.
  • Zwiers C, Oepkes D, Lopriore E, Klumper FJ, de Haas M, van Kamp IL. The near disappearance of fetal hydrops in relation to current state-of-the-art management of red cell alloimmunization. Prenat Diagn. 2018;38(12):943-50. Epub 2018/09/07. doi: 10.1002/pd.5355. PubMed PMID: 30187936; PubMed Central PMCID: PMCPMC6282502.
  • Zwiers C, Lindenburg ITM, Klumper FJ, de Haas M, Oepkes D, Van Kamp IL. Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol. 2017;50(2):180-6. Epub 2016/10/06. doi: 10.1002/uog.17319. PubMed PMID: 27706858; PubMed Central PMCID: PMCPMC5601196.
  • Lindenburg IT, van Kamp IL, van Zwet EW, Middeldorp JM, Klumper FJ, Oepkes D. Increased perinatal loss after intrauterine transfusion for alloimmune anaemia before 20 weeks of gestation. BJOG. 2013;120(7):847-52. Epub 2013/04/05. doi: 10.1111/1471-0528.12063. PubMed PMID: 23551577.
  • Pasman SA, Claes L, Lewi L, Van Schoubroeck D, Debeer A, Emonds M, et al. Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14 years experience in Leuven. Facts Views Vis Obgyn. 2015;7(2):129-36. Epub 2015/07/16. PubMed PMID: 26175890; PubMed Central PMCID: PMCPMC4498170.
Year 2024, Volume: 41 Issue: 2, 324 - 326, 19.05.2024

Abstract

References

  • Bowman JM. Controversies in Rh prophylaxis. Who needs Rh immune globulin and when should it be given? Am J Obstet Gynecol. 1985;151(3):289-94. Epub 1985/02/01. doi: 10.1016/0002-9378(85)90288-1. PubMed PMID: 2982267.
  • Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ, Jr., et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med. 2000;342(1):9-14. Epub 2000/01/06. doi: 10.1056/NEJM200001063420102. PubMed PMID: 10620643.
  • Urbaniak SJ, Greiss MA. RhD haemolytic disease of the fetus and the newborn. Blood Rev. 2000;14(1):44-61. Epub 2000/05/11. doi: 10.1054/blre.1999.0123. PubMed PMID: 10805260.
  • Savkli AO, Cetin BA, Acar Z, Ozkose Z, Behram M, Caypinar SS, et al. Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation. J Obstet Gynaecol. 2020;40(5):649-53. Epub 2019/08/30. doi: 10.1080/01443615.2019.1647521. PubMed PMID: 31462132.
  • Arslan E, Demir SC, Ozsurmeli M, Akcabay C. Perinatal outcomes and survival predictors of severe red-cell alloimmunization treated by intrauterine transfusion. J Obstet Gynaecol Res. 2021;47(8):2632-40. Epub 2021/05/22. doi: 10.1111/jog.14860. PubMed PMID: 34018269.
  • Nicolaides KH, Soothill PW, Clewell WH, Rodeck CH, Mibashan RS, Campbell S. Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet. 1988;1(8594):1073-5. Epub 1988/05/14. doi: 10.1016/s0140-6736(88)91896-x. PubMed PMID: 2452938.
  • Mandelbrot L, Daffos F, Forestier F, MacAleese J, Descombey D. Assessment of fetal blood volume for computer-assisted management of in utero transfusion. Fetal Ther. 1988;3(1-2):60-6. Epub 1988/01/01. doi: 10.1159/000263335. PubMed PMID: 3257068.
  • Ghesquiere L, Houfflin-Debarge V, Behal H, Coulon C, Subtil D, Vaast P, et al. Should optimal timing between two intrauterine transfusions be based on estimated daily decrease of hemoglobin or on measurement of fetal middle cerebral artery peak systolic velocity? Transfusion. 2017;57(4):899-904. Epub 2017/03/16. doi: 10.1111/trf.13980. PubMed PMID: 28295352.
  • Branger B, Winer N. [Epidemiology of anti-D allo-immunization during pregnancy]. J Gynecol Obstet Biol Reprod (Paris). 2006;35(1 Suppl):1S87-1S92. Epub 2006/02/24. PubMed PMID: 16495833.
  • Schumacher B, Moise KJ, Jr. Fetal transfusion for red blood cell alloimmunization in pregnancy. Obstet Gynecol. 1996;88(1):137-50. Epub 1996/07/01. doi: 10.1016/0029-7844(96)00113-5. PubMed PMID: 8684747.
  • Zwiers C, Oepkes D, Lopriore E, Klumper FJ, de Haas M, van Kamp IL. The near disappearance of fetal hydrops in relation to current state-of-the-art management of red cell alloimmunization. Prenat Diagn. 2018;38(12):943-50. Epub 2018/09/07. doi: 10.1002/pd.5355. PubMed PMID: 30187936; PubMed Central PMCID: PMCPMC6282502.
  • Zwiers C, Lindenburg ITM, Klumper FJ, de Haas M, Oepkes D, Van Kamp IL. Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol. 2017;50(2):180-6. Epub 2016/10/06. doi: 10.1002/uog.17319. PubMed PMID: 27706858; PubMed Central PMCID: PMCPMC5601196.
  • Lindenburg IT, van Kamp IL, van Zwet EW, Middeldorp JM, Klumper FJ, Oepkes D. Increased perinatal loss after intrauterine transfusion for alloimmune anaemia before 20 weeks of gestation. BJOG. 2013;120(7):847-52. Epub 2013/04/05. doi: 10.1111/1471-0528.12063. PubMed PMID: 23551577.
  • Pasman SA, Claes L, Lewi L, Van Schoubroeck D, Debeer A, Emonds M, et al. Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14 years experience in Leuven. Facts Views Vis Obgyn. 2015;7(2):129-36. Epub 2015/07/16. PubMed PMID: 26175890; PubMed Central PMCID: PMCPMC4498170.
There are 14 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Murat Aykut Özek 0000-0003-2874-6958

Tuncay Yüce 0000-0002-7085-5878

Publication Date May 19, 2024
Submission Date November 30, 2023
Acceptance Date March 26, 2024
Published in Issue Year 2024 Volume: 41 Issue: 2

Cite

APA Özek, M. A., & Yüce, T. (2024). Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization. Journal of Experimental and Clinical Medicine, 41(2), 324-326.
AMA Özek MA, Yüce T. Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization. J. Exp. Clin. Med. May 2024;41(2):324-326.
Chicago Özek, Murat Aykut, and Tuncay Yüce. “Perinatal Outcomes of Intrauterine Transfusions Performed for RhD Alloimmunization”. Journal of Experimental and Clinical Medicine 41, no. 2 (May 2024): 324-26.
EndNote Özek MA, Yüce T (May 1, 2024) Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization. Journal of Experimental and Clinical Medicine 41 2 324–326.
IEEE M. A. Özek and T. Yüce, “Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization”, J. Exp. Clin. Med., vol. 41, no. 2, pp. 324–326, 2024.
ISNAD Özek, Murat Aykut - Yüce, Tuncay. “Perinatal Outcomes of Intrauterine Transfusions Performed for RhD Alloimmunization”. Journal of Experimental and Clinical Medicine 41/2 (May 2024), 324-326.
JAMA Özek MA, Yüce T. Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization. J. Exp. Clin. Med. 2024;41:324–326.
MLA Özek, Murat Aykut and Tuncay Yüce. “Perinatal Outcomes of Intrauterine Transfusions Performed for RhD Alloimmunization”. Journal of Experimental and Clinical Medicine, vol. 41, no. 2, 2024, pp. 324-6.
Vancouver Özek MA, Yüce T. Perinatal outcomes of intrauterine transfusions performed for RhD alloimmunization. J. Exp. Clin. Med. 2024;41(2):324-6.