Mizuuchi Masahito, Murotsuki Jun, Ishii Keisuke, Yamamoto Ryo, Sasahara Jun, Wada Seiji, Takahashi Yuichiro, Nakata Masahiko, Murakoshi Takeshi, Sago Haruhiko
Department of Obstetrics, Sapporo Medical University, Sapporo, Japan.
Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan.
J Obstet Gynaecol Res. 2021 Jun;47(6):2076-2081. doi: 10.1111/jog.14746. Epub 2021 Mar 15.
The present study investigated the current situation regarding intrauterine blood transfusion (IUT) for fetal anemia in Japan.
We conducted a nationwide, multicenter, retrospective cohort questionnaire survey for cases that underwent IUT from 2011 to 2015. The questionnaire required perioperative information, indications, details of the procedure, procedure-related complications, and neonatal morbidity.
A total of 100 IUT procedures were performed in 66 cases at 19 institutions during the study period. The most frequent indication of IUT was complicated monochorionic diamniotic (MCDA) twins in 28 (42.4%) cases, followed by 16 (24.2%) cases of red-cell alloimmunization, and 10 (15.2%) cases of parvovirus B19 infection. IUT was performed through the umbilical cord in the vast of majority cases (92%). Bleeding from the IUT site was the most common adverse event (40%). Two cases (2%) underwent emergency cesarean section after the procedure. There were no cases of rupture of membrane or intrauterine infection after IUT. The neonatal survival rate was 77.3% in the 66 total cases and 64% in the hydrops cases. The neonatal survival rates in MCDA twins, red-cell alloimmunization, and parvovirus B19 infection were 75%, 93.8%, and 70%, respectively.
IUT was performed for mainly three indications in Japan: MCDA twins, red-cell alloimmunization, and parvovirus B19 infection. The incidences of severe adverse events seemed very low. The outcomes after IUT were favorable with variations in survival rates according to indications. However, further studies with long-term follow-up will be required to assess the effectiveness of IUT, especially for complicated MCDA twins.
本研究调查了日本胎儿贫血宫内输血（IUT）的现状。
我们对2011年至2015年接受IUT的病例进行了一项全国性、多中心、回顾性队列问卷调查。问卷要求提供围手术期信息、适应症、手术细节、手术相关并发症和新生儿发病率。
在研究期间，19家机构的66例患者共进行了100次IUT手术。IUT最常见的适应症是复杂单绒毛膜双羊膜囊（MCDA）双胎，共28例（42.4%），其次是16例（24.2%）红细胞同种免疫，10例（15.2%）细小病毒B19感染。绝大多数病例（92%）通过脐带进行IUT。IUT部位出血是最常见的不良事件（40%）。2例（2%）在手术后接受了急诊剖宫产。IUT后没有发生胎膜破裂或宫内感染的病例。66例总病例的新生儿存活率为77.3%，水肿病例为64%。MCDA双胎、红细胞同种免疫和细小病毒B19感染的新生儿存活率分别为75%、93.8%和70%。
在日本，IUT主要用于三种适应症：MCDA双胎、红细胞同种免疫和细小病毒B19感染。严重不良事件的发生率似乎很低。IUT后的结果良好，存活率因适应症而异。然而，需要进一步的长期随访研究来评估IUT的有效性，特别是对于复杂的MCDA双胎。
