Early procedure-related complications of fetal blood sampling and intrauterine transfusion for fetal anemia

Abstract

OBJECTIVE: To review the procedure-related complication rates following fetal blood sampling and intrauterine red cell transfusion for anaemic fetuses at a single tertiary center. DESIGN: A retrospective study of 114 intrauterine transfusions. SETTING: A single tertiary referral fetal medicine center at Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK. SAMPLE: All cases (114) undergoing fetal blood sampling and intrauterine transfusion between January 2003 and May 2010. METHODS: Early procedure-related complications (severe fetal bradycardia requiring either abandonment of the procedure or emergency delivery, fetal death, preterm labor or rupture of membranes) were investigated by review of computerized records and individual chart review. MAIN OUTCOME MEASURES: Live birth rate, perinatal mortality, procedure-related fetal bradycardia, preterm labor and procedure-related spontaneous rupture of membranes. RESULTS: The majority of cases (77.8%) were due to red cell alloimmunization, with anti-D being the commonest cause. The live birth rate was 93.5%, with a procedure-related fetal death rate of 0.9%. The preterm labor rate (<37 weeks' gestation) was 3.5% only occurring in patients undergoing multiple (>3) fetal transfusions. Complications in this series did not appear to be increased the earlier the gestation at which the first transfusion took place. CONCLUSIONS: Despite a reduction in the number of cases requiring intrauterine therapy for fetal anemia, contemporary outcomes appear to be good if not improving. It is important that the experience required to manage these cases should be concentrated in fewer centers to maximize good perinatal outcome.