Garabedian C, Philippe M, Vaast P, Wibaut B, Salleron J, Delsalle A, Rakza T, Subtil D, Houfflin-Debarge V
Department of Obstetrics, Pôle Femme Mère Nouveau-né, Jeanne de Flandre Hospital, CHRU Lille, France.
Department of Obstetrics and Gynecology, Roubaix Hospital Center, France.
Eur J Obstet Gynecol Reprod Biol. 2014 Aug;179:83-7. doi: 10.1016/j.ejogrb.2014.05.008. Epub 2014 May 20.
To study modalities and complications of intrauterine exchange transfusion (IUET) for the management of severe fetal anaemia.
Retrospective study of all IUET procedures performed between January 1999 and January 2012 at a regional centre. Characteristics of each procedure were studied to identify risk factors for complications. Survival rates according to the different aetiologies of anaemia were evaluated.
In total, 225 IUET procedures were performed in 96 fetuses. Major indications were feto-maternal erythrocyte alloimmunization (n=80/96, 83.3%) and parvovirus B19 infection (n=13/96, 13.5%). Twenty-six percent of the fetuses (25/96) had hydrops fetalis before the first IUET. Intrauterine fetal death occurred after 2.7% (6/225) of procedures, premature rupture of the membranes occurred after 0.9% (2/225) of procedures, and emergency caesarean section was required after 3.6% (8/225) of procedures. Fetal bradycardia [odds ratio (OR) 37, 95% confidence interval (CI) 8.3-170; p<0.01] and gestational age up to 32 weeks (OR 3.67; 95% CI, 1.07-12.58; p=0.038] were significantly associated with complications after IUET. Complications occurred in 17.7% of pregnancies (17/96) and 7.5% of IUET procedures (17/225). The overall survival rate in the study cohort was 87.5% (84/96): 90% (72/80) in the alloimmunization group and 76.9% (10/13) in the parvovirus-infected group (NS).
IUET has a higher complication rate than simple intrauterine transfusion, and should be performed by well-trained specialists.
研究宫内换血疗法（IUET）治疗严重胎儿贫血的方式及并发症。
对1999年1月至2012年1月在某区域中心进行的所有IUET手术进行回顾性研究。研究每个手术的特征以确定并发症的危险因素。评估根据不同贫血病因的生存率。
共对96例胎儿进行了225次IUET手术。主要指征为胎儿-母体红细胞同种免疫（n = 80/96，83.3%）和细小病毒B19感染（n = 13/96，13.5%）。26%的胎儿（25/96）在首次IUET前出现胎儿水肿。2.7%（6/225）的手术术后发生宫内胎儿死亡，0.9%（2/225）的手术术后发生胎膜早破，3.6%（8/225）的手术术后需要紧急剖宫产。胎儿心动过缓[比值比（OR）37，95%置信区间（CI）8.3 - 170；p < 0.01]和孕周达32周（OR 3.67；95% CI，1.07 - 12.58；p = 0.038）与IUET术后并发症显著相关。17.7%的妊娠（17/96）和7.5%的IUET手术（17/225）发生并发症。研究队列的总生存率为87.5%（84/96）：同种免疫组为90%（72/80），细小病毒感染组为76.9%（10/13）（无显著性差异）。
IUET的并发症发生率高于单纯宫内输血，应由训练有素的专家进行操作。
