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Increased perinatal loss after intrauterine transfusion for alloimmune anaemia before 20 weeks of gestation
Author(s) -
Lindenburg ITM,
Kamp IL,
Zwet EW,
Middeldorp JM,
Klumper FJCM,
Oepkes D
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12063
Subject(s) - gestation , medicine , obstetrics , fetus , gestational age , pregnancy , retrospective cohort study , gynecology , surgery , genetics , biology
Objectives To evaluate and compare perinatal outcome after intrauterine transfusions ( IUT ) performed before and after 20 weeks of gestation. To analyse contributing factors. Design Retrospective analysis. Setting The Dutch referral centre for fetal therapy. Population IUT s for fetal alloimmune anaemia. Methods Fetuses were divided into two groups: fetuses requiring the first IUT before 20 weeks of gestation (Group 1) and those in which the IUT s started after 20 weeks (Group 2). The cause of perinatal loss was classified as procedure‐related ( PR ) or not procedure‐related ( NPR ). The cohort was divided into two periods to describe the change of perinatal loss over time. Main outcome measures Perinatal loss of fetuses requiring the first IUT before 20 weeks of gestation, compared with perinatal loss later in gestation. Results A total of 1422 IUT s were performed in 491 fetuses. Perinatal loss rate in Group 1 was higher (7/29 24% versus 35/462 8%, P = 0.002). Especially NPR was higher for IUT s performed before 20 weeks (4/37 11% versus 19/1385 1%, P < 0.001). Kell alloimmunisation was overrepresented in Group 1 (7/29 24% versus 52/462 11%, P = 0.04). In a multivariate regression analysis, only hydrops was independently associated with perinatal loss ( P = 0.001). In recent years, a decline in total perinatal loss was found (36/224 16% versus 6/267 2%, P < 0.001), but perinatal loss in Group 1 did not decline (4/224 1.8% versus 3/267 1.1%, P = 0.5). Conclusions Perinatal loss after IUT performed before 20 weeks of gestation is increased compared with loss after IUT performed later in gestation. In addition, we confirmed earlier observations that hydrops is a major contributor to adverse outcome. Early and timely detection and treatment may prevent hydrops and improve outcome.