RESUMO

Objetivo: evaluar los resultados perinatales de las pacientes isoinmunizadas sometidas a transfusión fetal intrauterina en el Instituto Fernandes Figueira (Río de Janeiro, Brasil). Materiales y métodos: estudio descriptivo retrospectivo, que incluyó a mujeres que requirieron transfusión fetal intrauterina entre 1996 y 2006. Se analizaron la historia perinatal, los datos de la asistencia prenatal durante la gestación actual y los resultados perinatales. Resultados: a un total de 85 madres isoinmunizadas, 90 gestaciones y 94 fetos (4 gestaciones gemelares) se les hicieron 316 transfusiones intrauterinas. Todas las 90 gestaciones exhibían anticuerpos anti-Rh(D). Doce fetos (12,8) demostraban hidropesía en la primera transfusión y cinco (5,3%) tenían ascitis. Ocurrieron diez óbitos perinatales (4 óbitos fetales y 6 óbitos neonatales), totalizando una sobrevida de 89,4%. Fetos sin hidropesía tuvieron una sobrevida de 92,2% y fetos que presentaron hidropesía tuvieron un peor pronóstico, con sobrevida de 76,5%. Conclusiones: los resultados descritos confirman la eficacia y seguridad de la transfusión fetal intrauterina para el tratamiento de la anemia hemolítica inmune, realizada en centros de referencia para enfermedades perinatales.

Objective: evaluating the perinatal results of isoimmunised pregnancies submitted to intrauterine foetal transfusion at the Fernandes Figueira Institute (Rio de Janeiro, Brazil). Patients and methods: this was a retrospective descriptive review of the charts of isoimmunised pregnant women submitted to intrauterine foetal transfusion from 1996 to 2006. Perinatal history, antenatal assistance at the index pregnancy and perinatal outcomes were assessed. Results: 316 intra-uterine transfusions were given to 85 pregnant women (to correct foetal anaemia), 90 pregnancies and 94 foetuses(4 twin pregnancies). All 90 pregnancies had the anti-Rh(D) antibody. Twelve foetuses (12.8%) were hydropic at the first intrauterine transfusion and 5 (5.3% percent) presented ascitis. Survival rate was 89.4%, with 4 foetal deaths and 6 neonatal deaths. However, perinatal survival was 92.2% for non-hydropic foetuses and 76.5% for hydropic ones. Conclusions: these results confirmed the safety and efficacy of intrauterine transfusion when treating immune haemolytic anaemia if these procedures are performed in reference units for perinatal assistance when high-risk conditions are involved.

Objetivo: avaliar os resultados perinatais de gestantes isoimunizadas submetidas à transfusão intra-uterina no Instituto Fernandes Figueira (Rio de Janeiro, Brasil). Material e métodos: estudodescritivo,retrospectivo,oqualincluiugestantessubmetidasàtransfusão intra-uterina para correção da anemia hemolítica fetal entre 1996 e 2006. Foi analisado o histórico perinatal, os dados referentes à assistência pré-natal durante a gestação e os resultados perinatais. Resultados: 85 mulheres foram submetidas à transfusão intra-uterina, totalizando 90 gestações, 94 fetos (4 gestações gemelares) e 316 transfusões. Todas as gestantes tinham anticorpos anti-Rh(D). Doze fetos (12,8%) estavam hidrópicos quando da primeira transfusão e 5 (5,3%) tinham ascite isolada. Houve dez óbitos perinatais (4 óbitos fetais e 6 neomortos), totalizando uma sobrevida de 89,4%. Fetos sem hidropisia tiveram sobrevida de 92,2%, porémfetoshidrópicosapresentaramumpiorprognóstico, com sobrevida de 76,5%. Conclusões: os resultados descritos confirmam a eficácia e a segurança da transfusão intra-uterina para o tratamento da anemia hemolítica fetal quando realizadas em uma unidade de referência para a assistência perinatal.

Assuntos

RESUMO

OBJECTIVE: To evaluate the influence of fetal hydrops and other variables on fetal hematocrit (Hct) decrease after the first intrauterine transfusion (IUT) in alloimmunized pregnancies. METHODS: From 1996 to 2006, the data of all alloimmunized pregnancies submitted to IUT were assessed. Exclusion criteria included: fetuses submitted to intraperitoneal transfusion; pregnancies complicated by other fetal abnormalities; pregnancies submitted to only one IUT, and cases in which posttransfusion or pretransfusion blood samples were not obtained. Linear regression models were implemented to assess the relationship between the rate of Hct fall after the first IUT and the following variables: fetal hydrops; antibody titer; gestational age at the first IUT; number of days between the first and second IUT; pretransfusion and posttransfusion fetal Hct values. RESULTS: Fifty fetuses fulfilled the study criteria. The fetal Hct decrease after the first IUT was 1.21 (range 0.18-2.3) %/day. The variables independently associated with the fetal Hct drop after the first IUT were the fetal hydrops (p = 0.000), the pretransfusion fetal Hct (p = 0.001) and the posttransfusion fetal Hct (p = 0.016). CONCLUSION: Fetal hydrops, pretransfusion fetal Hct and posttransfusion fetal Hct seem to influence the fetal Hct decrease between the first and second IUT. These findings may be helpful for estimating the rate of fetal Hct drop and programming the following IUT.

Assuntos

RESUMO

BACKGROUND: To evaluate the relationship between obstetric history and Rh(D) alloimmunization severity, employing the gestational age at the first intrauterine fetal transfusion (IUT) as an indicator of this severity. METHODS: From 1996 to 2006, Rh(D) alloimmunized pregnancies submitted to IUT had their data assessed. Gestational age at the first IUT was modeled as a linear outcome. The associations between obstetric history variables, anti-Rh(D) antibodies titer and gestational age at the first IUT were analyzed. Statistics are presented with 95% confidence intervals (P < 0.05). RESULTS: A total of 82 non-hydropic anemic fetuses, ensuing in 92.7% (n = 76) of perinatal survival, were submitted to IUT. Nineteen (23,2%) pregnant women did not present with any previous stillbirth, neonatal death, IUT, hydrops or neonatal exchange transfusion (group 1); and 63 (76.8%) reported at least one of these events (group 2). Gestational age at the first IUT differed significantly between the groups (P = 0.0001). For group 1, it ranged from 24 to 35 weeks (median 32.5 weeks), whereas for group 2 it ranged from 19 to 34 weeks (median 27 weeks). In the multivariated analysis, previous neonatal death (P = 0.040), previous IUT (P = 0.000) and previous neonatal exchange transfusion (P = 0.036) were independently associated with the gestational age at the first IUT. CONCLUSIONS: The evaluation of the obstetrical history is an important diagnostic tool for predicting Rh(D) alloimmunization severity. Alloimmunized pregnant women who reported previous neonatal death(s), neonatal exchange transfusion(s) or IUT(s) should receive a closer fetal surveillance due to the risk of a higher rate of fetal hemolysis and the need of an earlier IUT.

Assuntos

RESUMO

BACKGROUND: The aim of this study is to evaluate the fetal hematocrit (Hct) decrease along repeated intravascular intrauterine fetal transfusions (IUTs) and test the hypothesis that, after consecutive IUTs, there is a lower Hct drop off. METHODS: From July 1996 to June 2006, pregnancies submitted to IUT for fetal hemolytic anemia treatment had their data assessed. The daily rate of decrease in fetal Hct was calculated by dividing the difference between the posttransfusion Hct of the previous IUT and the pretransfusion Hct of the current IUT, by the number of days between the transfusions. Fetuses with other abnormalities or submitted to intraperitoneal transfusions were excluded. RESULTS: Eighty-one women were submitted to IUT during the alluded period, ensuing 296 intrauterine transfusions. The perinatal survival was 89.9% (n = 80), with 92.0% (n = 69) of nonhydropic fetuses survival. Hydropic fetuses showed higher hematocrit drop off than nonhydropic ones (P < 0.01). Compared to the interval between the first and second IUT, the daily fetal Hct decline was lower after the third one (P < 0.05). Stratifying by the presence of hydrops, nonhydropic fetuses showed a smaller decrease at the third and fourth intervals (P < 0.01 and P < 0.05, respectively). Among hydropic fetuses, there is a trend of smaller Hct decrease along successive IUTs (interval 3, P = 0.08; interval 4, P = 0.07; and interval 5, P = 0.10). CONCLUSIONS: Following some IUTs, fetal hematocrit decrease is lower and larger intervals between the transfusions could be accomplished. Multicenter studies should investigate an algorithm for timing subsequent IUTs, considering Doppler values, estimated fetal hematocrit decline and other parameters.

Assuntos