Abstract
Objective
To determine the antenatal course of severe red cell alloimmunisation in pregnancies
requiring intrauterine fetal transfusion.
Study design
A retrospective cohort study over 16 years in a single national quaternary fetal medicine
centre. From 1996 to 2011, 242 red cell intrauterine transfusions (IUT) were performed
in 102 alloimmunised pregnancies. Antibody type was categorized into Rh(D) and non-Rh(D)
(including Rh(c), Kell and Rh(E)). Women with Rh(D) antibodies were further stratified
into those with and without additional red cell antibodies. Data were compared using
the Mann–Whitney U and Fisher's exact tests. Two-tailed P values at the 5% level were considered significant.
Results
Comparing Rh(D) and non-Rh(D) pregnancies, there were no differences in either gestational
age or fetal haemoglobin at first IUT, number of transfusions required, gestation
at delivery, caesarean delivery rates or perinatal losses. In women sensitized to
Rh(D), the presence of additional antibodies did not influence the degree of fetal
anaemia or the first transfusion-delivery interval, although rates of fetal hydrops
were higher in the presence of multiple antibodies. The “procedure-related” loss rate
was 1.7% per procedure in our institution.
Conclusion
Antibody status does not appear to influence clinical outcomes following fetal transfusion
for alloimmunisation.
Keywords
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References
- Noninvasive approach for the management of hemolytic disease of the fetus.Expert Rev Hematol. 2009; 2: 577-582
- Management and prevention of red cell alloimmunisation in pregnancy: a systematic review.Obstet Gynecol. 2012; 120: 1132-1139
- Rhesus alloimmunisation in pregnancy: a tertiary care centre experience in the Western region of Saudi Arabia.Saudi Med J. 2011; 32: 1039-1045
- Noninvasive diagnosis by Doppler ultrasonography of fetal anaemia due to maternal red-cell alloimmunisation. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses.N Engl J Med. 2000; 342: 9-14
- DIAMOND Study Group. Sonography versus amniocentesis to predict fetal anaemia.N Engl J Med. 2006; 355: 156-164
- ACOG Practice Bulletin No. 75: management of alloimmunisation during pregnancy.Obstet Gynecol. 2006; 108: 457-564
- Complications of intrauterine intravascular transfusion for fetal anaemia due to maternal red-cell alloimmunisation.Am J Obstet Gynecol. 2005; 192: 171-177
- Intrauterine fetal transfusions in the management of fetal anaemia and fetal thrombocytopenia.Semin Fetal Neonatal Med. 2007; 12: 432-438
- High additional maternal red cell alloimmunisation after Rhesus- and K-matched intrauterine intravascular transfusions for hemolytic disease of the fetus.Am J Obstet Gynecol. 2007; 196: e1-e6
- Fetoplacental blood volume estimation in pregnancies with Rh alloimmunisation.Fetal Diagn Ther. 1990; 5: 138-146
- Appropriate antenatal corticosteroid use in women at risk for preterm birth before 34 weeks of gestation.Br J Obstet Gynaecol. 2010; 117: 963-967
- Procedure-related complications of amniocentesis and chorionic villous sampling: a systematic review.Obstet Gynecol. 2007; 110: 687-694
- Fetal anaemia due to non-Rhesus-D red-cell alloimmunisation.Semin Fetal Neonatal Med. 2008; 13: 207-214
- Effect of screening for red cell antibodies, other than anti-D, to detect hemolytic disease of the fetus and newborn: a population study in the Netherlands.Transfusion (Paris). 2008; 48: 941-952
- Procedure-related complications and perinatal outcome after intrauterine transfusions in red cell alloimmunisation in Stockholm.Fetal Diagn Ther. 2011; 30: 266-273
- Early procedure-related complications of fetal blood sampling and intrauterine transfusion for fetal anaemia.Acta Obstet Gynecol Scand. 2012; 91: 458-462
- Increased perinatal loss after intrauterine transfusion for alloimmune anaemia before 20 weeks of gestation.Br J Obstet Gynaecol. 2013; 120: 847-852
- Death in utero due to Kell sensitization without excessive elevation of the delta OD450 value in amniotic fluid.Obstet Gynecol. 1982; 60: 746-749
- Management of pregnancies complicated by anti-Kell isoimmunization.Obstet Gynecol. 1999; 93: 667-673
- Non-anti-D antibodies in red-cell alloimmunisation.Eur J Obstet Gynecol Reprod Biol. 2000; 92: 75-81
- Benefits and risks of fetal red-cell transfusion after 32 weeks gestation.Eur J Obstet Gynecol Reprod Biol. 2000; 92: 91-96
- Management of isoimmunization in the presence of multiple maternal antibodies.Am J Obstet Gynecol. 2001; 185: 481-484
Article info
Publication history
Published online: September 16, 2013
Accepted:
September 2,
2013
Received in revised form:
July 31,
2013
Received:
May 17,
2013
Footnotes
☆This study was presented at the 32nd Annual Meeting of the Society for Maternal–Fetal Medicine in Dallas, TX, February 2012 (abstract no. 341).
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
