Klumper F J, van Kamp I L, Vandenbussche F P, Meerman R H, Oepkes D, Scherjon S A, Eilers P H, Kanhai H H
Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2000 Sep;92(1):91-6. doi: 10.1016/s0301-2115(00)00430-9.
To compare the outcome after intrauterine transfusion (IUT) between fetuses treated before and those treated after 32 weeks gestation.
National referral center for intrauterine treatment of red-cell alloimmunization in The Netherlands.
Retrospective evaluation of an 11 year period, during which 209 fetuses were treated for alloimmune hemolytic disease with 609 red-cell IUTs. We compared fetal and neonatal outcome in three groups: fetuses only treated before 32 weeks gestation (group A, n=46), those treated both before and after 32 weeks (group B, n=117), and those where IUT was started at or after 32 weeks (group C, n=46).
Survival rate was 48% in group A, 100% in group B, and 91% in group C. Moreover, fetuses in group A were hydropic significantly more often. Short-term perinatal loss rate after IUT was 3.4% in the 409 procedures performed before 32 weeks and 1.0% in the 200 procedures performed after 32 weeks gestation.
Perinatal losses were much more common in fetuses only treated before 32 weeks gestation. Two procedure-related perinatal losses in 200 IUT after 32 weeks remain a matter of concern because of the good prospects of alternative extrauterine treatment.
比较妊娠32周之前接受宫内输血（IUT）治疗的胎儿与妊娠32周之后接受治疗的胎儿的治疗结果。
荷兰全国红细胞同种免疫宫内治疗转诊中心。
对11年期间进行的回顾性评估，在此期间，209例胎儿因同种免疫溶血病接受了609次红细胞宫内输血治疗。我们比较了三组胎儿和新生儿的治疗结果：仅在妊娠32周之前接受治疗的胎儿（A组，n = 46）、在妊娠32周之前和之后均接受治疗的胎儿（B组，n = 117）以及在妊娠32周及之后开始进行宫内输血治疗的胎儿（C组，n = 46）。
A组的存活率为48%，B组为100%，C组为91%。此外，A组胎儿出现水肿的情况明显更为常见。在妊娠32周之前进行的409次宫内输血治疗中，短期围产期损失率为3.4%，在妊娠32周之后进行的200次宫内输血治疗中，该损失率为1.0%。
仅在妊娠32周之前接受治疗的胎儿中，围产期损失更为常见。由于宫外替代治疗前景良好，妊娠32周之后进行的200次宫内输血治疗中有两例与手术相关的围产期损失仍令人担忧。
