Short-term outcomes following intrauterine transfusions for fetal anaemia: A retrospective cohort study.

Abstract

Intrauterine transfusion (IUT) is the accepted standard for management of severe fetal anaemia. However, fetal transfusion may be associated with procedural complications such as fetal demise. There is a paucity of recent data on outcomes for severe fetal anaemia in Australia as compared with published outcomes from large international centres. To review the indications for and the procedural, obstetric and neonatal outcomes following intrauterine transfusion for fetal anaemia conducted at the New South Wales Fetal Therapy Centre (NSW FTC). Retrospective cohort study conducted between 2005 and 2017 of the outcomes of 85 IUT procedures (39 pregnancies). Data collected included maternal demographics, procedural and obstetric details and short-term neonatal outcomes. Complete outcome data were available for 36/39 pregnancies. Red cell antibodies were the main indication for fetal transfusion (79%, predominantly D, Kell and other Rhesus antibodies) with parvovirus accounting for 8% of procedures. IUT was associated with a pregnancy loss rate of 1.2%/procedure, amounting to 2.6%/pregnancy. Fetal losses were limited to those complicated by hydrops prior to IUT (3/10 hydrops vs 0/26 non-hydropic; P=0.003). Procedural outcomes at NSW FTC compare favourably with international centres (1.1-8.7% procedural loss rate). However, this comparison is limited, as no procedures were performed during the last 24months of the study. Given this, a nationwide audit is recommended to help guide appropriate centralisation of procedures and thereby maximise clinician experience and outcome.