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Alloimmunization in twin pregnancies.

J M Bowman

    American Journal of Obstetrics and Gynecology
    |September 1, 1985
    PubMed
    Summary
    This summary is machine-generated.

    Early intrauterine fetal transfusion for Rh disease in twins significantly improves survival rates. Timely intervention, ideally by 23 weeks gestation, is crucial for managing Rh alloimmunization in multiple births.

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    Area of Science:

    • Obstetrics and Gynecology
    • Perinatology
    • Neonatology

    Background:

    • Rh alloimmunization poses a significant risk to fetuses, particularly in twin gestations.
    • Managing Rh disease in twins presents unique challenges due to shared placental circulation and potential for differing fetal involvement.

    Purpose of the Study:

    • To evaluate the effectiveness of intrauterine fetal transfusion (IUFT) in improving survival rates for twins affected by Rh alloimmunization.
    • To determine optimal timing for IUFT intervention in Rh-alloimmunized twin pregnancies.

    Main Methods:

    • Retrospective analysis of 118 twins from 59 alloimmunized mothers (1944-1984).
    • Review of cases undergoing intrauterine fetal transfusion, including timing and outcomes.
    • Comparison of survival rates based on gestational age at referral and intervention.

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    Main Results:

    • Six of 118 twins died; one set of twins and four referred sets underwent IUFT, with survival in the Manitoba twin and two referred pairs.
    • Fetal transfusions were initiated between 22 and 24 weeks gestation in surviving sets.
    • Referral at 23 weeks gestation suggested a potential 62.5% survival rate for hydropic twins.

    Conclusions:

    • Intrauterine fetal transfusion can be a life-saving intervention for Rh-alloimmunized twins.
    • Early referral and intervention by 23 weeks gestation are critical for maximizing survival in Rh-alloimmunized twins.
    • Factors like twin-to-twin transfusion, sex, Rh constitution, and fetal function may influence disease severity in dichorionic twins.