Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures

ABSTRACT Objective Maternal alloimmunization to fetal red‐blood‐cell antigens is a major cause of fetal anemia, which can lead to hydrops and perinatal death if untreated. The cornerstone of management during pregnancy is intrauterine intravascular blood transfusion (IUT). Although this procedure is...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2017-08, Vol.50 (2), p.180-186
Main Authors: Zwiers, C., Lindenburg, I. T. M., Klumper, F. J., de Haas, M., Oepkes, D., Van Kamp, I. L.
Format: Article
Language:English
Subjects:
Anemia
Antigens
Avoidance
Blood transfusion
Blood Transfusion, Intrauterine - adverse effects
Blood Transfusion, Intrauterine - utilization
Blood transfusions
Cohort Studies
Complications
Edema
Erythroblastosis, Fetal - mortality
Erythroblastosis, Fetal - therapy
Erythrocytes
Female
fetal anemia
Fetuses
Gynecology
Humans
Identification methods
intrauterine blood transfusion
Isoimmunization
Netherlands
Obstetrics
Original Paper
Original Papers
Outcome Assessment (Health Care)
Paralysis
perinatal loss
Postoperative Complications
Pregnancy
Pregnancy complications
Pregnancy Outcome
procedure‐related complication
red‐cell alloimmunization in pregnancy
Retrospective Studies
Survival Analysis
Therapy
Transfusion
Ultrasound
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Summary:ABSTRACT Objective Maternal alloimmunization to fetal red‐blood‐cell antigens is a major cause of fetal anemia, which can lead to hydrops and perinatal death if untreated. The cornerstone of management during pregnancy is intrauterine intravascular blood transfusion (IUT). Although this procedure is considered relatively safe, complications continue to occur. The aim of this study was to evaluate rates of procedure‐related complications and perinatal loss following IUT, and their change over time, in order to identify factors leading to improved outcome. Methods This was a retrospective analysis of all IUTs for red‐cell alloimmunization performed at the national referral center for fetal therapy in The Netherlands, from 1988 to 2015. Differences in complication rates and their associations with alterations in transfusion technique after 2001 were assessed. Results Between 1988 and 2015, 1678 IUTs were performed in 589 fetuses. For IUTs performed in 2001 and onwards, there was significant improvement in survival (88.6% vs 97.0%, P < 0.001) and a decline in procedure‐related complications per fetus (9.8% vs 3.3%, P = 0.001) and per procedure (3.4% vs 1.2%, P = 0.003) compared with those performed before 2001. Procedure‐related perinatal loss declined from 4.7% to 1.8% per fetus (P = 0.053). Beneficial changes in transfusion technique were routine use of fetal paralysis, increased use of intrahepatic transfusion and avoidance of arterial puncture. Conclusions IUT has become an increasingly safe procedure in recent years when performed by experienced hands. The chosen technique should be fine‐tuned according to the patient's individual situation. The declining complication rates are most likely related to center volume: this rare procedure is best performed in experienced fetal therapy centers. © 2016 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
ISSN:0960-7692
1469-0705
DOI:10.1002/uog.17319