Perinatal results in Rh(D) alloimmunised pregnancies submitted to intrauterine foetal transfusion in Rio de Janeiro, Brazil. A case series from 1996 to 2006
DOI:
https://doi.org/10.18597/rcog.355Keywords:
Rh isoimmunisation, intrauterine blood transfusionAbstract
Objective: evaluating the perinatal results of isoimmunised pregnancies submitted to intrauterine foetal transfusion at the Fernandes Figueira Institute (Rio de Janeiro, Brazil).
Patients and methods: this was a retrospective descriptive review of the charts of isoimmunised pregnant women submitted to intrauterine foetal transfusion from 1996 to 2006. Perinatal history, antenatal assistance at the index pregnancy and perinatal outcomes were assessed.
Results: 316 intra-uterine transfusions were given to 85 pregnant women (to correct foetal anaemia), 90pregnanciesand94foetuses(4twinpregnancies). All 90 pregnancies had the anti-Rh(D) antibody. Twelve foetuses (12.8%) were hydropic at the first intrauterine transfusion and 5 (5.3%) presented ascitis. Survival rate was 89.4%, with 4 foetal deaths and 6 neonatal deaths. However, perinatal survival was 92.2% for non-hydropic foetuses and 76.5% for hydropic ones.
Conclusions: theseresultsconfirmedthesafetyand efficacy of intrauterine transfusion when treating immune haemolytic anaemia if these procedures are performed in reference units for perinatal assistance when high-risk conditions are involved.
Author Biographies
Gustavo Lobato
Cristina Silveira Soncini
References
Moise KJ, Jr. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol 2002;100:600-11.
Rh-Disease: a perinatal success story. Obstet Gynecol 2002;100:405-6.
Chavez GF, Mulinare J, Edmonds LD. Epidemiology of Rh hemolytic disease of the newborn in the United States. JAMA 1991;265:3270-4.
Amorim-Filho LM, Ximenes GV, Susana TC, Mello SM, Castilho SL, Lopes MED. Reasons for anti-D alloimmunization in Brazilian Blood Donors. Transfusion 2003;43:96A.
Conde-Agudelo A, Belizan JM, Diaz-Rossello JL. Epidemiology of fetal death in Latin America. Acta Obstet Gynecol Scand 2000;79:371-8.
Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: final data for 2001. Natl Vital Stat Rep 2002;18:1-102.
Mari G, Zimmermann R, Moise KJ, Jr., Deter RL. Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions. Am J Obstet Gynecol 2005;193:1117-20.
Liley AW. Intrauterine transfusion of fetus in haemolytic disease. BMJ 1963;2:1107-9.
Rodeck CH, Nicolaides KH, Warsof SL, Fysh WJ, Gamsu RH, Kemp JR. The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions. Am J Obstet Gynecol 1984;150:769-74.
Nardozza LMM, Camano L, Moron AF, Chinen PA, Torloni MR, Cordioli E, et al. Perinatal mortality in Rh alloimmunized patients. Eur J Obstet Gynecol Reprod Biol 2007;132:159-62.
van Kamp IL, Klumper FJ, Meerman RH, Oepkes D, Scherjon SA, Kanhai HH. Treatment of fetal anemia due to red-cell alloimmunization with intrauterine transfusions in the Netherlands, 1988-1999. Acta Obstet Gynecol Scand 2004;83:731-7.
Hudon L, Moise KJ, Jr, Hegemier SE, Hill RM, Moise AA, Smith EO, et al. Long-term neurodevelopmental outcome after intrauterine transfusion for the treatment of fetal hemolytic disease. Am J Obstet Gynecol 1998;179:858-63.
Mari G, DeterRL, 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;342:9-14.
Liley AW. Liquor amnii analysis in the management of thepregnancycomplicatedbyRhesussensitization.Am J Obstet Gynecol 1961;82:1359-70.
Lobato G, Soncini CS. Fetal hematocrit decrease after repeated intravascular transfusions in alloimmunized pregnancies. Arch Gynecol Obstet 2007;276:595-9.
Cabral ACV, Taveira MR, Lopes APBM, Pereira AK, Leite HV. Transfusão intra-uterina na isoimunização materna pelo fator Rh. Rev Bras Ginecol Obstet 2001;23:299-303.
PoissonnierMH, Brossard Y, Demedeiros N, Vassileva J, Parnet F, Larsen M, et al. Two hundred intrauterine exchange transfusions in severe blood incompatibilities. Am J Obstet Gynecol 1989;161:709-13.
Nardozza LM, Moron AF, Araújo Junior E, Camano L, Chinen PA, Torloni MR. Rh alloimmunization: Doppler or amniotic fluid analysis in the prediction of fetal anemia? Arch Gynecol Obstet 2007;275:107-11.
Oepkes D, Seaward PG, Vandenbussche FP, Windrim R, Kingdom J, Beyene J, et al. Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med 2006;355:156-64.
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