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Abstract
Objective
We undertook this study to determine the clinical characteristics and the prognostic factors of neonatal survival in patients with fetal anemia who were treated by intraumbilical venous transfusion (IUT).
Methods
From July 2000 to March 2009, 16 cases of fetal anemia were diagnosed at Asan Medical Center in Seoul, Korea. These patients underwent intraumbilical venous transfusions and were thus included in our study. Doppler measurement of the middle cerebral artery peak systolic velocity was performed before and after cordocentesis in all fetuses.
Results
The gestational age at the time of the diagnosis of anemia ranged from 21.3 to 33.6 weeks. There was a linear correlation between pre- and post-procedure fetal hemoglobin (Hb,MoM, (x)) and the MCA-PSV (MoM, (y)), i.e., y=0.810-0.229x, r2=0.542, CI 0.316-0.141, p<0.005; and y=1.374-0.391x, r2=0.499, CI 0.584-0.197, p<0.005. The survival was better in patients with severe anemia than those with mild to moderate anemia (p<0.05), and survival was better in patients with anemia of a known cause than those with anemia of an unknown cause (p<0.001).
Conclusion
In fetuses with anemia, the severity of the anemia before IUT and the change of hemoglobin concentration after IUT, can be estimated noninvasively using Doppler ultrasonography, on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. Both severity and etiology were meaningful factors for the survival of neonates with fetal anemia who were treated by intraumbilical venous transfusion. Although fetuses have severe anemia, they expected improved survival through IUT. These data are valuable information for use when counseling the parents of an affected fetus.
Figures and Tables
Figure 1
Correlation between middle cerebral artery peak systolic velocity (MCA-PSV, MoM) and hemoglobin concentration (Hb, MoM) in 35 samples taken from fetuses with anemia before intraumbilical transfusion. r2=0.542; P<0.001; y=0.810-0.229x; CI 0.141-0.316. MoM: multiples of median.
Figure 2
Correlation between middle cerebral artery peak systolic velocity (MCA-PSV, MoM) and hemoglobin concentration (Hb, MoM) in samples taken from fetuses with anemia after intraumbilical transfusion. y=1.374-0.391x; CI 0.197-0.584, r2=0.499; P<0.001. MoM: multiples of median.
Figure 3
Box-plot for the fetal hematocrit daily decrease (%) between the first and second intraumbilical venou transfusions (IUT) between second and third intrauterine transfusion in fetus with anemia (A), and individual patient data showing the change of hematocrit (Hct) before and after IUT (B). The middle line of the box represents the median, and the upper and lower perimeters of the box represent the 75th and 25th, respectively. Upper adjacent value (upper tail) represents the largest data value that is less than or equal to the thirdquartile plus 1.5×IQR (interquartile range, the difference between the 75th and 25th centiles), and the lower adjacent value (lower tail) represents the smallest data value that is greater than or equal to the first quartile minus 1/5×IQR.
Figure 4
The perinatal overall survival of patients with known cause was significantly better than those of patients with unknown cause (P<0.05).
Figure 5
The perinatal overall survival of patients with severe anemia was significantly better than those of patients with mild to moderate anemia (P<0.001).
Table 1
Clinical details of 16 cases with fetal anemia treated by intraumbilical venous transfusion
GA: gestational age, IUT: intraumbilical venous transfusion, HD: hydrops, PCE: pericardial effusion, PE: pleural effusion, AC: ascites, CM: cardiomegaly, Hb: hemoglobin, Hct; hematocrit, BWT: birth weight, AS: Apgar score, NS: neonatal survival, ND: neonatal death, FDIU: fetal death intrauterine, TOP: termination of pregnancy, C/S: cesarean section. E)C/S: emergent cesarean section.
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