Intra-uterine Transfusions to the Rhesus-Immunized Fetus in the Department of Obstetrics, National Hospital, Oslo 1968–1979. The Fetal Prognosis by Intra-uterine Transfusions in Relation to Amniotic Fluid Blood Pigment Index

The present authors report a critical retrospective study of intrauterine transfusions to Rh-immunized fetuses. During the years 1966–1979, 115 transfusions were performed in 71 severely Rh-immunized pregnant women at 26–32 weeksʼ gestation. The selection of patients requiring intrauterine transfusions was based on a combined evaluation of the anamnestic data and amniotic fluid analyses. The decisions have nearly always been dependent on repeated amniocenteses.Thirty-five babies (49.3 per cent) survived. Thirty-seven (including one set of twins) died either in utero (28) or in the neonatal period (9). Eighteen of the surviving babies were delivered by cesarean section, 14 of them at gestational ages of 34–36 weeks. In 3 patients, vaginal delivery was induced at about 35 weeks, and the remaining 14 gravida went into spontaneous labor at gestational ages of 27–34 weeks (before 32 weeks in 4 cases only). In the authorsʼ series, as in many others, rupture of the membranes with unintended labor was the most frequent complication, particularly after repeated antrauterine transfusions.The gestational ages of the 5 babies who died in the neonatal period ranged from 28 to 34 weeks. Six were severely hydropic, and 3 babies died from complications linked with immaturity, the immature labors probably being induced by the intrauterine transfusions. There were 28 cases of intrauterine death16 after one transfusion, 10 after two, and 3 after three. No case of serious maternal complications occurred. In the neonatal period, the surviving infants were given an average of 4.2 exchange transfusions (range, 1–11).In 7 of the 35 survivors, no demonstrable Rh-positive erythrocytes in cord blood were present at birth, but all 7 were found to be positive later. In 18 of the 35, less than 4 gm of fetal hemoglobin were found. Between 4 and 8 gm were found in 5, and no calculations were made for the remaining 5.Of the nine babies that died in the neonatal period, all but one had less than 7 gm of hemoglobin in cord blood at birth. In two cases, less than 25 per cent of the blood was of fetal origin; in three cases, between 25 and 50 per cent was of fetal origin; in one, more than 50 per cent was of fetal origin; and in the last three cases, estimations were not made.The patients were divided into three groups, according to the degree of hemolysis expressed by the optical density difference. There was a highly significant inverse correlation between the optical density difference and