OC026: Fetal neurosonography in severe RH alloimmunization

Abstract

The occurrence of abnormal neurodevelopment in survivors after intrauterine transfusion is rare but has been previously documented. We herein describe three fetuses with severe anemia and hydrops in which antenatal neurosonography demonstrated abnormal findings. Three midtrimester fetuses with severe Rh alloimmunization, anemia and hydrops were evaluated with multiplanar neurosonography using a transvaginal approach before and after intravascular transfusion. In all cases, hemoglobin concentration was between 1 and 1.8 g/dL. In all cases, brain edema was noted before the transfusion. In two cases hemorrhage was demonstrated afterwards (one intraventricular grade II and infratentorial, one infratentorial). In the remaining case mild ventriculomegaly developed. The fetus with intraventricular and infratentorial hemorrhage was terminated at the request of the couple and the antenatal diagnosis was confirmed by the postmortem examination. The other two pregnancies continued. The fetus with infratentorial hemorrhage developed hypoplasia of the affected cerebellar hemisphere that was confirmed by both intrauterine and postnatal Magnetic resonance. In the other infant, mild ventriculomegaly resolved in utero and the neonatal neurosonogram was normal. Both infants were delivered after 34 weeks by elective cesarean section and had an uneventful neonatal course. Neurologic examination was within normal limits at one year and two months' of life respectively. The outcome of cases with extreme anemia that are resuscitated by intrauterine transfusion has never been specifically investigated. In published series, brain damage has been although rarely reported. The pathophysiology is uncertain, and is commonly related to preterm birth. We provide evidence that in some cases at least brain injury may occur prenatally. Our experience suggests a role for fetal neurosonography in pregnancies with severe Rh alloimmunization undergoing intrauterine transfusions.