Early intraperitoneal transfusion and adjuvant maternal immunoglobulin therapy in the treatment of severe red cell alloimmunization prior to fetal intravascular transfusion.

This descriptive case study documents the treatment of a cohort of 6 women with pregnancies complicated by red cell alloimmunization who in previous pregnancies had objective evidence of severe fetal anemia prior to 20 weeks of gestation, with accompanying high perinatal loss (66% mortality). In the pregnancies described, 5 singletons and 1 dichorionic, diamniotic twin pregnancy underwent alternate week, serial intraperitoneal transfusions between 16 and 21 weeks, until a gestation when classical fetal intravascular transfusions could be commenced. In addition, 4 women consented to have additional, adjuvant maternal intravenous gammaglobulin (IVIG) therapy (0.8 g/kg per week). At the first fetal blood sampling at a median gestational age of 22 weeks (95% CI 21.2-23.4 weeks) the median hemoglobin concentration was 10.1 g% (95% CI 7.4-13.4 g%). In only 2 cases were the fetal hemoglobin levels at fetal blood sampling between -2 SD and -5 SD for gestational age; in 1 case this was associated with fetal mortality. This cohort indicates that such treatment may prevent severe fetal anemia from developing prior to 20 weeks and, in this cohort, indicated an improved survival of pregnancies (86% survival (6/7)), as compared to the previous history. The only perinatal mortality occurred in a growth-restricted fetus whose mother had a chronic opiate addiction. The fetus died prior to 20 weeks. Of the pregnancies that progressed beyond 20 weeks and commenced classical fetal intravascular transfusions, the survival was 100%.