Outcome of severely anemic fetuses treated by intrauterine transfusions.

Abstract

Objective: Fetal anemia is a well known complication of pregnancy which might have an ominous effect on the course of the pregnancy, labor and child's development. The aim of this study was to assess the effect of the severity of fetal anemia on child's outcome.

Methods: A retrospective cohort study. Pregnancies treated by intra-uterine transfusions at "Sheba" medical center for fetal anemia (years 1996-2004) were divided into two groups: mild to moderate anemia (fetal hematocrit>0.50MoM) and severe anemia (hydrops fetalis or fetal hematocrit ≤0.50MoM). Data were retrieved from relevant obstetric and fetal medicine files.

Results: During the study period, 54 fetuses were treated by 154 (median=3; range 1-7) intrauterine transfusions due to red-cell alloimmunization. The sensitizing antigen was D in 70% of cases . 18/54 patients were sensitized to more than one antigen. 33/54 fetuses (61.1%) were categorized as severely anemic (Hct range 3-20%). Six of the fetuses with severe anemia were hydropic. 21/54 fetuses (38.9%) were categorized as mild-moderate anemia (Hct range 20-37). On prenatal evaluation, there were no sonographic markers of CNS abnormalities or intra-ventricular hemorrhage. There were no differences in the neonatal outcome between these two groups. Developmental outcome was available for 14/18 (78%) mild-moderate cases and 26/29 (89%) severe cases. There were no significant differences in motor development score, percent of abnormal cognitive development, and percent of children needing supportive therapy between the mild and severe cases.

Conclusion: Neonatal and developmental outcome of fetuses treated for severe anemia is comparable to cases of mild anemia.