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PF.55 Intrauterine Transfusion For Parvovirus B19 Infection Over Last Decade
  1. P Wu,
  2. AD Cameron,
  3. JL Gibson,
  4. J Brennand,
  5. MA Ledingham
  1. The Ian Donald Fetal Medicine Unit, Southern General Hospital, Glasgow, UK

Abstract

Intrauterine transfusion (IUT) cases for Parvovirus B19 infection over 2002–2011 were reviewed. Our unit receives referrals from Scotland and Northern Ireland. Most were referred in 2008 (n = 5) and 2009 (n = 7). In other years there were <3 cases.

Thirty patients underwent 48 IUTs (mean 1.6, range 1–3). Twenty-six fetuses had middle cerebral artery Doppler peak systolic velocity values documented. All were >1.5 multiples of median prior to first IUT. At initial assessment, 25 fetuses were hydropic and 4 had ascites. Pre-IUT haematocrit value was available in 27 pregnancies: <10% in 15 and 10–19% in 5 cases, in keeping with fetal anaemia. Initial IUT was most frequently performed between 21–24 (n = 13) followed by 17–20 weeks gestation (n = 9) (range 17–32 weeks).

Intrauterine or neonatal death occurred in 9 hydropic fetuses that had bradycardia, thrombocytopenia, difficult procedure or severe anaemia. No reasons were identified in 2 cases. However, these did not have pre-transfusion haematocrit values. Seven procedures had other complications e.g. cord haematoma, technically difficult, bradycardia and spontaneous rupture of membranes. This pregnancy was conservatively managed with a live birth at 36 weeks gestation.

Live births occurred in 14 pregnancies. Seven women were lost to follow-up. Improved capture of outcome data is required. Short term outcomes were available in 8 neonates: 6 required no treatment, 1 had phototherapy and 1 had a neonatal death. We conclude that poor outcomes following IUT can be predicted at the time of procedure and that IUT can rescue a fetus destined for intrauterine loss to a healthy outcome.

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