Table 2.
Characteristics and fetal complications and outcomes among women with complications and fetal deaths after undergoing intrauterine transfusions performed in Oman over a four-year period (N = 11)
| Baseline | At first IUT | At time of complication | Outcomes | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cause of HDFN (titre) | Maternal history | GA in weeks | Hb level in g/dL | Presence of HF | IUT approach | GA in weeks | Number of IUTs | Complication | Prenatal/ delivery | Postnatal | Follow-up | |
| 1 | anti-D (1:1024) | G6/P3/A2; 2 previous LSCS | 26 | 3.7 | No | TPI | 30 | 3 | Abnormal CTG measurements within 24 hours of the IUT | Emergency LSCS | Required TUT and PHT | Healthy at four years post-delivery |
| 2 | anti-Jsb (1:128) | G2/P0; 2 previous IUFDs due to HF | 22 | 1.5 | Yes | TPI | 29 | 4 | Cord haematoma leading to interruption of the IUT | Emergency LSCS | Required TUT and PHT | Healthy and undergoing PT at four years post-delivery |
| 3 | anti-D (>1:2,048) | G4/P4; 4 previous LSCS with AP† | 30 | 5.0 | Yes | TPI | 30 | 1 | Preterm labour by LSCS due to previous LSCS history | Emergency LSCS | Required TUT and PHT; neonate had early ND sequelae that resolved upon follow-up | Healthy at three years post-delivery |
| 4 | anti-D (1:2,048) | G7/P4/A2; 3 previous LSCS‡ | 19 | - | Yes | IP | 19 | 1 | IUFD due to severe initial HF and DC cardiac status | IUFD | - | - |
| 5 | anti-D (1:1,024) | G3/P3; 1 previous emergency LSCS due to FA§ | 25 | 3.0 | Yes | IC | 25 | 1 | Cardiac tamponade | IUFD | - | - |
| 9 | Non-immune HF due to B19 | G0/P0 | 20 | 5.0 | Yes | TPI | 20 | 1 | IUFD due to severe initial HF and DC cardiac status | IUFD | - | - |
| 10 | anti-D | G2/P2; 1 previous LSCS due to HF¶ | 22 | 2.2 | Yes | TPI | 22 | 2 | IUFD due to severe HF and DC cardiac status | IUFD | - | - |
| 11 | anti-K | G6/P5; 1 previous IUFD with HF | 29 | 3.9 | Yes | TPI | 31 | 3 | PPROM due to PHD// | Emergency LSCS | Neonatal death due to severe cardiac dysfunction// | - |
IUT = intrauterine transfusion; HDFN = haemolytic disease of the fetus and newborn; GA = gestational age; Hb = haemoglobin; HF = hydrops fetalis; G = gravida; P = para; A = abortus; LSCS = low-segment Caesarean section; TPI = trans-placental intravascular; CTG = cardiotocography; TUT = top-up transfusion; PHT = phototherapy; PT = physiotherapy; AP = abnormal placentation; ND = neurodevelopmental; IP = intra-peritoneal; DC = decompensated; IUFD = intrauterine fetal death; FA = fetal anaemia; IC = intracardiac; B19 = parvovirus B19; K = Kell; PPROM = preterm premature rupture of the membrane; PHD = polyhydramnios.
A total of 28 IUTs were performed for 13 fetuses carried by 11 women.
Of these, three neonates required PHT and one had an IUT.
Of these, one pregnancy was affected by severe FA, with the fetus surviving following IUT.
Preterm delivery at 32 gestational weeks.
Preterm delivery.
At 32 gestational weeks.