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PF.20 Intrauterine Transfusion For Rhesus Isoimmunisation in Scotland
  1. P Wu,
  2. AD Cameron,
  3. JL Gibson,
  4. MA Ledingham,
  5. J Brennand
  1. The Ian Donald Fetal Medicine Unit, Southern General Hospital, Glasgow, UK

Abstract

Scottish intrauterine transfusion (IUT) cases for severe Rhesus isoimmunisation over 2002–2011 were reviewed. One hundred and forty-one pregnancies underwent 437 IUTs (mean 3.09, range 1–8).

One hundred and thirty-one fetuses had middle cerebral artery Doppler peak systolic velocity values documented. All were >1.5 multiples of median prior to the first IUT, except for one that was inactive with a pericardial effusion. Twelve fetuses were hydropic. The haematocrit value prior to initial IUT was 20–29% in 38% of cases, whilst 27% had a haematocrit between 10–19%. Initial IUT was most commonly performed between 29–32 weeks gestation (35%) followed by 25–28 (26%) and 21–24 (21%) weeks gestation (range 17–25 weeks).

In the majority of cases, fetus was transfused via umbilical vein (80%). Fourteen percent of transfusions were performed intrahepatically, 3% intraperitoneally and 3% were undocumented. Complications occurred in 58 (13%) IUTs and include cord haematoma, difficult procedure, bradycardia or tachycardia necessitating unplanned delivery, and in utero death (5 fetuses). The procedure-related loss rate was 1%.

Birth outcomes were documented in 108 cases with a 94% live birth rate (n = 102). One patient underwent termination of pregnancy for trisomy 21. Short term postnatal outcomes were available for 86 neonates: 33 neonates required phototherapy only, with 31 cases requiring top-up transfusions. Nine neonates had an exchange transfusion and 9 had immunoglobulin or erythropoietin. Four neonates did not require any treatment. We conclude that our live birth and procedure-related loss rates are consistent with other published series. Parents need to be aware of potential postnatal therapies.

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