Guilbaud Lucie, Garabedian Charles, Cortey Anne, Rakza Thameur, Carbonne Bruno, Houfflin-Debarge Véronique
Unité d'obstétrique et unité clinique du Centre National de Référence en Hémobiologie Périnatale (CNRHP), Pôle Périnatalité Hôpital Trousseau, Paris, France.
Clinique d'obstétrique, Pôle Femme-Mère-Nouveau-né, CHRU Lille, France.
Eur J Obstet Gynecol Reprod Biol. 2016 Jun;201:85-8. doi: 10.1016/j.ejogrb.2016.03.037. Epub 2016 Apr 1.
To compare in utero exchange transfusions (IUET) and in utero simple transfusions (IUST) for the treatment of fetal anemia resulting from red blood cell fetomaternal incompatibility.
Retrospective comparative study from January 2006 through December 2011. The two techniques were compared for effectiveness, complications, and neonatal outcomes.
36 patients had 87 IUETs and 85 patients 241 IUSTs. Gestational age at the first transfusion was similar in both groups (IUET: 27±3.8 weeks; IUST: 27±4.7 weeks; NS) as was the initial fetal hemoglobin level (IUET: 6.4±2.8g/dL; IUST: 6.0±2.5g/dL; NS). No significant differences were noted for postprocedure complications or efficacy. The daily drop in hemoglobin level was similar in both groups (IUET: 0.41±0.23g/dL/day; IUST: 0.44±0.17g/dL/day; NS) as were the time intervals between two procedures. Gestational age at birth was earlier in the IUET group (34.4±1.3 weeks vs 35.5±1.8 weeks; p<0.001), but the postnatal transfusions or exchange transfusions rates and the duration of intensive phototherapy did not differ. No significant differences were noted for the overall survival rates (IUET: 100%; IUST: 96.4%; p>0.99).
IUET does not appear to provide any benefits compared with IUST, neither to be associated with a higher complication rate. The choice of the technique depends on availability of packed blood cells with high hematocrit (70-80%).
比较宫内换血输血（IUET）和宫内单纯输血（IUST）治疗红细胞母婴血型不合所致胎儿贫血的效果。
2006年1月至2011年12月的回顾性比较研究。比较两种技术的有效性、并发症及新生儿结局。
36例患者接受了87次IUET，85例患者接受了241次IUST。两组首次输血时的孕周相似（IUET：27±3.8周；IUST：27±4.7周；无统计学差异），初始胎儿血红蛋白水平也相似（IUET：6.4±2.8g/dL；IUST：6.0±2.5g/dL；无统计学差异）。术后并发症或疗效方面未发现显著差异。两组血红蛋白水平每日下降幅度相似（IUET：0.41±0.23g/dL/天；IUST：0.44±0.17g/dL/天；无统计学差异），两次输血的时间间隔也相似。IUET组出生时孕周较早（34.4±1.3周 vs 35.5±1.8周；p<0.001），但出生后输血或换血输血率及强化光疗持续时间无差异。总体生存率无显著差异（IUET：100%；IUST：96.4%；p>0.99）。
与IUST相比，IUET似乎没有任何优势，也未显示出更高的并发症发生率。技术的选择取决于高血细胞比容（70-80%）浓缩红细胞的可获得性。
