Intrauterine Fetal Blood Transfusion (IUBT) for Rh Incompatibility - 12 Years' Experience from Pakistan

Area of Science:

• Perinatology
• Maternal-Fetal Medicine
• Neonatology

Background:

• Rh-alloimmunisation poses a significant risk to fetal well-being, potentially leading to severe anemia and hydrops fetalis.
• Intrauterine blood transfusion (IUBT) is a critical intervention for managing fetal anemia caused by red cell alloimmunisation.
• Effective management requires timely diagnosis and intervention to optimize perinatal outcomes.

Purpose of the Study:

• To evaluate the perinatal outcomes of pregnancies complicated by Rh-alloimmunisation.
• To assess the efficacy and safety of intrauterine intravascular blood transfusion (IUBT) in managing fetal anemia.
• To identify factors influencing the success of IUBT in at-risk fetuses.

Main Methods:

• Retrospective analysis of 305 IUBT procedures performed on 127 fetuses between 2007 and 2019.
• Inclusion criteria: fetuses requiring IUBT for Rh-alloimmunisation or parvovirus B19-induced anemia.
• Transfusion routes included umbilical vein (preferred) and intra-cardiac (exceptional cases).

Main Results:

• A total of 305 IUBT procedures were conducted on 127 fetuses, with gestational ages at referral ranging from 18 to 32 weeks.
• The overall survival rate was 71.6%, with 14.2% loss to follow-up and 14.2% mortality.
• The infra-hepatic umbilical vein was the preferred route for transfusion, with the intra-cardiac route used in only two cases.

Conclusions:

• Intrauterine intravascular blood transfusion (IUBT) is a safe and effective procedure for salvaging fetuses at risk of anemia due to Rh-alloimmunisation.
• Timely referral of mothers with Rh-alloimmunisation, particularly before the development of hydrops fetalis, is crucial for improving fetal survival rates.
• Experienced healthcare providers enhance the safety and success of IUBT, contributing to better perinatal outcomes.