Intravenous fetal exchange transfusion before 22 weeks of gestation in early and severe red-cell fetomaternal alloimmunization.

OBJECTIVES: To determine the perinatal outcome in severe red-cell fetomaternal alloimmunization.

METHODS: Retrospective series of 32 affected fetuses treated with intravenous fetal exchange transfusion (IFET) before 22 weeks of gestation. The main outcome measures were the degree of fetal anemia, fetal transfusions and perinatal outcome.

RESULTS: The first IFET was performed at 19.8 +/- 1.8 weeks of gestation. All fetuses were severely anemic and hemoglobin levels were not different between 20 hydropic and 12 nonhydropic fetuses (4.1 +/- 2.5 vs. 5.6 +/- 2.8 g/dl, p=0.33). The initial maternal anti-D level ranged from 4 to 76 microg/l and was not correlated to fetal anemia (r=-0.07).

CONCLUSION: The overall perinatal survival rate was 78% compared to a previous perinatal loss rate excluding first pregnancies of 55.5%.