Abstract：
BACKGROUND: Fetal anemia from hemolytic disease treated by intrauterine transfusion (IUT) can be performed by intraperitoneal, intracardiac, and intravascular transfusion (IVT). Objective of our study was to compare different transfusion techniques.
METHODS: Retrospective review of IUT secondary to red cell alloimmunization was conducted at eight international centers from 2012 to 2020. Severe anemia suspected if middle cerebral artery peaks systolic velocity ≥1.5 multiples of the median. Demographic, delivery, and postnatal variables were analyzed.
RESULTS: Total of 344 procedures, 325 IVT and 19 other techniques (non-IVT) included. No difference in demographics, history of stillbirth (20.5 vs. 15.8%, p = 0.7), prior pregnancy IUT (25.6 vs. 31.6%, p = 0.5) or neonatal transfusion (36.1 vs. 43.8%, p = 0.5). At first IUT, non-IVT had higher hydrops (42.1% vs. 20.4%, p = 0.03), lower starting hematocrit (13.3% [±6] vs. 17.7% [±8.2], p = 0.04), and trend toward lower gestational age (24.6 [20.1-27] vs. 26.4 [23.2-29.6] weeks, p = 0.08). No difference in birthweight, neonatal phototherapy, exchange, or simple transfusion was observed.
CONCLUSIONS: This is one of the largest studies comparing techniques to treat fetal anemia. IVT was most performed, other techniques were more likely performed in hydrops, and lower starting hematocrit was seen. Neither technique affected outcomes. This study may suggest that physician\'s experience may be the strongest contributor of outcomes.
METHODS: Retrospective review of IUT secondary to red cell alloimmunization was conducted at eight international centers from 2012 to 2020. Severe anemia suspected if middle cerebral artery peaks systolic velocity ≥1.5 multiples of the median. Demographic, delivery, and postnatal variables were analyzed.
RESULTS: Total of 344 procedures, 325 IVT and 19 other techniques (non-IVT) included. No difference in demographics, history of stillbirth (20.5 vs. 15.8%, p = 0.7), prior pregnancy IUT (25.6 vs. 31.6%, p = 0.5) or neonatal transfusion (36.1 vs. 43.8%, p = 0.5). At first IUT, non-IVT had higher hydrops (42.1% vs. 20.4%, p = 0.03), lower starting hematocrit (13.3% [±6] vs. 17.7% [±8.2], p = 0.04), and trend toward lower gestational age (24.6 [20.1-27] vs. 26.4 [23.2-29.6] weeks, p = 0.08). No difference in birthweight, neonatal phototherapy, exchange, or simple transfusion was observed.
CONCLUSIONS: This is one of the largest studies comparing techniques to treat fetal anemia. IVT was most performed, other techniques were more likely performed in hydrops, and lower starting hematocrit was seen. Neither technique affected outcomes. This study may suggest that physician\'s experience may be the strongest contributor of outcomes.
摘要：
背景：通过宫内输血（IUT）治疗的溶血性疾病引起的胎儿贫血可以通过腹膜内进行，心内和血管内输血（IVT）。我们的研究目的是比较不同的输血技术。
方法：回顾性回顾2012-2020年8个国际中心的红细胞同种异体免疫继发IUT。怀疑严重贫血，如果大脑中动脉收缩期峰值流速≥1.5MoM。人口统计,分析了分娩和产后变量。
结果：总共344个程序，包括325个IVT和19个其他技术（非IVT）。人口统计学没有差异，死胎史（20.5vs15.8%，p=0.7),怀孕前IUT（25.6vs31.6%，p=0.5）或新生儿输血（36.1vs43.8%，p=0.5)。起初IUT,非IVT患者的积液较高(42.1%vs.20.4%,p=0.03),较低的起始血细胞比容(13.3%(±6)与17.7%(±8.2),p=0.04）和降低胎龄的趋势（24.6（20.1-27）与26.4（23.2-29.6）周，p=0.08)。出生体重没有差异，新生儿光疗，交换或简单的输血。
结论：这是比较治疗胎儿贫血技术的最大研究之一。IVT进行得最多，其他技术更有可能在积液中进行,并且观察到较低的起始血细胞比容.两种技术都不影响结果。这项研究可能表明，医生的经验可能是结果的最大贡献者。
方法：回顾性回顾2012-2020年8个国际中心的红细胞同种异体免疫继发IUT。怀疑严重贫血，如果大脑中动脉收缩期峰值流速≥1.5MoM。人口统计,分析了分娩和产后变量。
结果：总共344个程序，包括325个IVT和19个其他技术（非IVT）。人口统计学没有差异，死胎史（20.5vs15.8%，p=0.7),怀孕前IUT（25.6vs31.6%，p=0.5）或新生儿输血（36.1vs43.8%，p=0.5)。起初IUT,非IVT患者的积液较高(42.1%vs.20.4%,p=0.03),较低的起始血细胞比容(13.3%(±6)与17.7%(±8.2),p=0.04）和降低胎龄的趋势（24.6（20.1-27）与26.4（23.2-29.6）周，p=0.08)。出生体重没有差异，新生儿光疗，交换或简单的输血。
结论：这是比较治疗胎儿贫血技术的最大研究之一。IVT进行得最多，其他技术更有可能在积液中进行,并且观察到较低的起始血细胞比容.两种技术都不影响结果。这项研究可能表明，医生的经验可能是结果的最大贡献者。
