Ultrasound-guided fetal intravascular transfusions for severe erythroblastosis, 1984-1993

The results of the first 10 years' experience in ultrasound-guided fetal intravascular transfusions at the Royal Women's Hospital were reviewed. Since the first transfusion, a variety of techniques have been employed in 78 fetuses, all with severe erythroblastosis. A total of 288 intrauterine transfusions have been attempted with an overall survival rate of 75.6% (59 of 78). The overall survival rate for delivered fetuses improved from 64.3% (18 of 28) in 1984-1987, to 82.0% (41 of 50) in 1988-1993. There was a total of 33 hydropic fetuses, of whom 20 (60.6%) survived, significantly fewer compared with 86.7% (39 of 45) of the nonhydropic fetuses (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.09 to 0.70, p < .01). Fetuses who were sicker at the time of transfusion, as reflected by larger haemoglobin deficits, had lower survival rates, as did those requiring transfusions at earlier gestational ages. When these variables were allowed for, the survival rate significantly improved over time (OR 6.3, 95% CI 1.3 to 30.4, p < 0.05), probably reflecting the increased skill of the ultrasonologists, but the presence of hydrops per se was no longer important. Variations of the technique employed, such as exchange or intraperitoneal transfusion, or different sites for transfusion, were not significantly related to survival.