Analysis and perinatal outcome after intravascular transfusion

• Published in: Ginecologia y obstetricia de Mexico Vol. 79; no. 6; pp. 351 - 357
• Main Authors: Monico-Ramos, René, Ochoa-Flores, Mauro, Hernández-Herrera, Ricardo Jorge, Flores-Pompa, Eduardo
• Format: Journal Article
• Language: Spanish
• Published: Mexico 01.06.2011
• Subjects: Anemia, Hemolytic - epidemiology; Anemia, Hemolytic - etiology; Anemia, Hemolytic - therapy; Blood Flow Velocity; Blood Transfusion, Intrauterine - adverse effects; Blood Transfusion, Intrauterine - methods; Blood Transfusion, Intrauterine - statistics & numerical data; Cordocentesis; Erythroblastosis, Fetal - epidemiology; Erythroblastosis, Fetal - etiology; Female; Fetal Blood - chemistry; Fetal Death - epidemiology; Fetal Death - etiology; Fetal Diseases - blood; Fetal Diseases - epidemiology; Fetal Diseases - etiology; Fetal Diseases - therapy; Hemoglobins - analysis; Humans; Hydrops Fetalis - etiology; Hydrops Fetalis - mortality; Infant, Newborn; Middle Cerebral Artery; Pregnancy; Pregnancy Outcome; Prospective Studies; Rh Isoimmunization; Stillbirth - epidemiology
• ISSN: 0300-9041

the leading cause of fetal anemia is Rh isoimmunization. The timely diagnosis by ultrasound and intravascular transfusion improves the prognosis. to evaluate the increase in hemoglobin in the fetus and correlate the red cell transfusion volume with elevation of hemoglobin and perinatal outcome. prospective, case series study. We included 17 patients with fetal anemia detected by measuring the peak systolic velocity of middle cerebral artery and determination of fetal hemoglobin before and after cordocentesis. After confirmation of fetal anemia (Hb <10 g/dL), was held fetal transfusion with 50 mL/kg estimated fetal weight, with packed red blood cells type O Rh negative. In 17 cases fetal anemia was diagnosed, of which 11 (64%) had Rh isoimmunization and 6 (36%) were not immune. The 17 cases received 27 intravascular transfusions, in 75% hemoglobin rose to 10 g/dL, 45% in the first transfusion, 25% in the second and 10% in the third transfusion. Fetal hemoglobin between before and after transfusion was 6.5 and 12.9 g/dl, respectively (p<0.001) and allowed to continue the pregnancy from 3 to 12 weeks from the first transfusion. There were 4 deaths (2 stillbirths and 2 neonatal), but only one was related to the procedure. the survival rate was 76%, mortality in the presence of hydrops was 30% and no deaths in patients without hydrops. Mortality in fetal anemia was 23.6% and only one case was related to intravascular transfusion. In cases of survival to birth, pregnancy lasted >30 weeks gestation. Hemoglobin rose from 27 to 300% of the initial fetal hemoglobin. The presence of fetal hydrops significantly increases mortality.