FETAL TRANSFUSION FOR RED-BLOOD-CELL ALLOIMMUNIZATION IN PREGNANCY

Objective: To present an up-to-date review of the literature encompass ing all important aspects of fetal transfusion for red blood cell allo immunization in pregnancy. Data Sources: A MEDLINE computer data base search was conducted for pertinent articles through August 1995. Addit ional publications were identified by cross-referencing. Methods of St udy Selection: All pertinent references were reviewed by the authors, and their clinical significance in the fetal treatment of red blood ce ll alloimmunization was summarized. Tabulation, Integration, and Resul ts: Fetal intraperitoneal transfusion in the treatment of severe red b lood cell alloimmunization was first reported by Liley in 1963. Since then, major advancements have included intravascular techniques and fe tal paralysis. A total of seven different approaches have been used. C ase series describing fetal intravascular transfusion were reviewed, a nd outcomes were analyzed for all pregnancies and, separately, for tho se presenting with and without hydrops fetalis. Eighty-four percent of 411 fetuses that underwent intravascular transfusion had good outcome s. Ninety-four percent of nonhydrophobic fetuses and 74% of hydropic f etuses survived. Those with severe anemia but no hydrops at transfusio n were five times more likely to survive than fetuses already hydropic . Conclusion: For pregnant patients presenting with severe red blood c ell alloimmunization remote from term, fetal transfusion remains the b est available therapeutic option. It is a safe procedure with a perina tal loss rate of approximately 1-3%, and overall neonatal survival exc eeds 80%. It is the best available option until red blood cell alloimm unization can be prevented altogether.