Benefits and risks of fetal red-cell transfusion after 32 weeks gestation

Objective: To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation. Setting: National referral center for intrauterine treatment of red-cell alloimmunization in The Netherlands. Study Design: Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs. We compared fetal and neonatal outcome in three groups: fetuses only treated before 32 weeks gestation (group A, n = 46), those treated both before and after 32 weeks (group B, n = 117), and those where IUT was started at or after 32 weeks (group C, n = 46). Results: Survival rate was 48% in group A, 100% in group B, and 91% in group C. Moreover, fetuses in group A were hydropic significantly more often. Short-term perinatal loss rate after IUT was 3.4% in the 409 procedures performed before 32 weeks and 1.0% in the 200 procedures performed after 32 weeks gestation. Conclusion: Perinatal losses were much more common in fetuses only treated before 32 weeks gestation. Two procedure-related perinatal losses in 200 IUT after 32 weeks remain a matter of concern because of the good prospects of alternative extrauterine treatment. (C) 2000 Published by :Elsevier Science Ireland Ltd.