Management of fetal hemolytic disease by cordocentesis: II. Outcome of treatment

Abstract

Forty-eight of 128 pregnancies complicated by maternal red blood cell alloimmunization (49%) received a total of 142 intravascular transfusions (range, 1 to 7) for treatment of severe anemia (hematocrit, ⪯30%). Thirteen fetuses (27%) had hydrops when therapy was initiated. The overall survival rate was 96%. Eighty-five percent of survivors received two or more transfusions before delivery. The mean gestational age at initiation of therapy was 28 weeks (range, 18 to 36 weeks). Bleeding from uterine and umbilical cord puncture sites was not of clinical significance. The most common complication was fetal bradycardia (8%). Simple intravascular transfuson resulted in the replacement of fetal red blood cells with adult red blood cells and suppression of fetal erythropoiesis. By the completion of the second transfusion, on average, <1% of circulating red blood cells were fetal. Within 3 weeks of the second transfusion, the mean reticulocyte count was <1%. The rate at which the fetal hematocrit declined after a transfusion (exclusive of the first) was inversely related to gestational age (r = −0.84, p < 0.0001), permitting a 4- to 5-week interval between transfusions after 32 weeks' gestation. A total of 78% of surviving neonates were delivered at term. Neonates transfused more than once antenatally required less phototherapy (75.8 ± 54 vs 165 ± 101 hours, p < 0.003) and, when delivered at term, fewer hospital days (4.8 ± 2 vs 8.6 ± 6 days, p = 0.01 ) compared with those transfused once. We conclude that the treatment of fetal anemia by intrauterine simple intravascular transfusion permits a term delivery in the majority of cases and is associated with high perinatal survival and low perinatal morbidity. Forty-eight of 128 pregnancies complicated by maternal red blood cell alloimmunization (49%) received a total of 142 intravascular transfusions (range, 1 to 7) for treatment of severe anemia (hematocrit, ⪯30%). Thirteen fetuses (27%) had hydrops when therapy was initiated. The overall survival rate was 96%. Eighty-five percent of survivors received two or more transfusions before delivery. The mean gestational age at initiation of therapy was 28 weeks (range, 18 to 36 weeks). Bleeding from uterine and umbilical cord puncture sites was not of clinical significance. The most common complication was fetal bradycardia (8%). Simple intravascular transfuson resulted in the replacement of fetal red blood cells with adult red blood cells and suppression of fetal erythropoiesis. By the completion of the second transfusion, on average, <1% of circulating red blood cells were fetal. Within 3 weeks of the second transfusion, the mean reticulocyte count was <1%. The rate at which the fetal hematocrit declined after a transfusion (exclusive of the first) was inversely related to gestational age (r = −0.84, p < 0.0001), permitting a 4- to 5-week interval between transfusions after 32 weeks' gestation. A total of 78% of surviving neonates were delivered at term. Neonates transfused more than once antenatally required less phototherapy (75.8 ± 54 vs 165 ± 101 hours, p < 0.003) and, when delivered at term, fewer hospital days (4.8 ± 2 vs 8.6 ± 6 days, p = 0.01 ) compared with those transfused once. We conclude that the treatment of fetal anemia by intrauterine simple intravascular transfusion permits a term delivery in the majority of cases and is associated with high perinatal survival and low perinatal morbidity.