Intrauterine Transfusion for Fetal Anemia: An 8-Year Experience from a Tertiary Care Center.

Abstract

Aim and background: To study the procedure-related complications and outcomes of intrauterine transfusion (IUT) in fetal anemia.

Methods: A single tertiary care center, retrospective observational study of severe fetal anemia treated with IUT. The influence of gestational age (GA) at transfusion, hydrops, and route of transfusion on procedure-related complications were studied and the postnatal outcomes were recorded.

Results:  A total of 59 IUT's were performed in 33 anemic fetuses. Rh isoimmunization (30/33) was the most common indication in 90.9%. The mean GA of fetuses who developed procedural complications was 3 weeks earlier (Mean: 26 weeks) than in those in whom the procedure was uneventful (Mean: 29.8 weeks). The umbilical vein (UV) was the main route of entry in 86.4% of fetuses. All hydropic fetuses in the study needed an earlier transfusion than the nonhydropic ones. A total of six procedural complications were observed which varied from mild bradycardia (n = 1), intraperitoneal spill (n = 1), and preterm premature rupture of membranes (PPROM) (n = 1) to IUD (n = 3) of which with 2 IUD's, one PPROM and one intraperitoneal spill were seen in hydropic fetuses. The median age of delivery after IUT was 35 weeks. All neonates needed intensive phototherapy, 72% needed post-delivery transfusion, and 30% transfusion for late neonatal anemia.

Conclusion: Early GA of transfusion and the presence of hydrops increased procedure-related adverse events. Small sample size and confounding factors like hydrops and early gestational age at transfusions made it difficult to comment on the influence of route on procedure-related complications.