Complications of intravascular intrauterine transfusion for Rh alloimmunization.

Abstract

Background: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities.

Objective: Review the outcomes of Rh alloimmunization, including indications and possible complications.

Design: Retrospective cohort (medical record review).

Setting: Tertiary care center.

Patients and methods: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations.

Main outcome measure: Complications of IUT.

Sample size: 119 mothers with 154 fetuses (154 different pregnancies).

Results: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations.

Conclusions: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization).

Limitations: Case series.

Conflict of interest: None.