Complications of intravascular intrauterine transfusion for Rh alloimmunization

Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities.

Review the outcomes of Rh alloimmunization, including indications and possible complications.

Retrospective cohort (medical record review).

Tertiary care center.

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.

Complications of IUT.

119 mothers with 154 fetuses (154 different pregnancies).

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.

Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization).

Case series.

None.