General Obstetrics and Gynecology: ObstetricsComplications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization
Section snippets
Material and methods
Since 1965, the Department of Obstetrics at the Leiden University Medical Center is the single national referral center in the Netherlands for pregnancies complicated by maternal red-cell alloimmunization. Our methods for the management of alloimmunization in pregnancy have been described previously.5
Intraperitoneal transfusions for fetal anemia were performed until 1988; from that year onward, the intravascular approach became the routine method of treatment. From January 1988 to January 2001,
Results
A total of 740 intrauterine transfusions (median 3; range 1-7) were performed in 254 fetuses; 24 of the procedures were unsuccessful. Fetal anemia resulted from maternal Rh(D) alloimmunization in 217 of 254 (85%) pregnancies. There were 25 cases (10%) of Kell (K1) immunization and 9 (3.5%) of Rh(c) immunization. Rh(E), Rh(e), and Fya immunizations were present in 1 case each. Characteristics of the study population are summarized in Table I.
Fifty-one obstetric complications occurred in 43
Comment
In this study we found a procedure-related perinatal loss rate of fetal intravascular transfusion therapy of 1.6% per procedure from a cohort of 740 transfusions for fetal anemia because of maternal red-cell alloimmunization. The total PR complication rate was 3.1% per procedure, including rupture of membranes and preterm delivery, infection, emergency cesarean section, and perinatal death.
Fetal complications during or after an invasive procedure may result from either the procedure or the
Acknowledgments
We thank Dr. Saskia le Cessie, from the Department of Medical Statistics, for her advice in the statistical analysis of the data. Dr. Roland G.L. Devlieger, from the Department of Obstetrics, is gratefully acknowledged for classifying all complications.
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