PFM.11 Treatment of severe fetal anaemia before twenty weeks by intracardiac transfusion

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Abstract

Background

Severe alloimmunisation or parvovirus B19 infection (HPVB19) may cause fetal hydrops and severe anaemia at an early gestational age (GA). Fetal anaemia is associated with significant mortality but may be successfully treated by in-utero transfusion (IUT). Perinatal loss when performed prior to 20 weeks is significantly increased compared with procedures at later gestation. One case series from the 1980’s describes the safe use of ‘intracardiac transfusion’. 1

Methods

A retrospective case-cohort series of hydropic fetuses presenting in a Regional Fetal Medicine centre, prior to 20 weeks undergoing in-utero transfusion by intracardiac puncture between 2007–2013.

Results

Over a 6 year period a total of 202 in-utero transfusions were performed for fetal anaemia of which 7 (3.5%) were by intracardiac puncture (required due to accessing and transfusing through the umbilical vein. All pregnancies were complicated by fetal hydrops and presented at a median GA of 19.2 weeks (range 17.6–20). In 71.4% (5/7) the aetiology was HPVB19 infection, the remainder were secondary to rhesus disease (2/7). The median fetal haemoglobin at IUT was 3.3g% (range 1.3–6.1g%; all <5sd for GA) and the number of total IUTs performed ranged from 1–8. There were 2 IUDs (28.5%) associated with transfusion at early gestation (20–22 weeks). There were 5 live births (71.5%) at a median GA 36.1 weeks (range 33–38.1).

Conclusion

This small case cohort study indicates that intracardiac IUT is a feasible option to treat severely anaemic hydropic fetuses prior to 20 weeks gestation.

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