Background: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities.
Objective: Review the outcomes of Rh alloimmunization, including indications and possible complications.
Design: Retrospective cohort (medical record review).
Setting: Tertiary care center.
Patients and methods: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations.
Main outcome measure: Complications of IUT.
Sample size: 119 mothers with 154 fetuses (154 different pregnancies).
Results: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations.
Conclusions: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization).
Limitations: Case series.
Conflict of interest: None.Reference:
Alkhaibary A, Ali M, Tulbah M, Al-Nemer M, Khan RM, Al Mugbel M, Al Sahan N, Hassounah MM, Alshammari W, Kurdi WI. Complications of intravascular intrauterine transfusion for Rh alloimmunization. Ann Saudi Med. 2021 Nov-Dec;41(6):313-317. doi: 10.5144/0256-4947.2021.313. Epub 2021 Dec 2. PMID: 34873935; PMCID: PMC8650595.