TWELVE INTRAUTERINE TRANSFUSIONS IN THE EARLY EDEMATOUS FORM OF HEMOLYTIC DISEASE IN BOTH FETUSES WITH DICHORIONIC DIAMNIOTIC TWINS
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Abstract
This article presents the clinical case of successful intrauterine treatment of an edematous-anemic form of rhesus hemolytic disease in dichorionic diamniotic twins. Seven intrauterine blood transfusions were consecutively performed to the first fetus and five transfusions to the second ones from 24 weeks of pregnancy. The last intrauterine transfusions to both fetuses were performed at 36 1/7 weeks. The fetuses were delivered by cesarean section with a gestational age of 37 weeks. Two live term boys were born with an Apgar score of 9/9 and 8/9, a weight of 2920 and 2530 grams. The neonates did not need respiratory support and exchange blood transfusions.
Conclusion. This clinical case demonstrates the possibility of prolonging a multiple pregnancy in Rh-immunized patient with severe fetal hemolytic disease to a full term and achieving favorable perinatal outcomes, provided that early detection and timely correction of severy anemia in both fetuses by serial intrauterine blood transfusions.
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Klinicheskie rekomendacii – Rezus-izoimmunizaciya. Gemoliticheskaya bolezn` ploda – 2020 (02.11.2020) – Utverzhdeny` Minzdravom RF. Russian (Клинические рекомендации – Резус-изоиммунизация. Гемолитическая болезнь плода – 2020 (02.11.2020) – Утверждены Минздравом РФ)
Mikhailov AV, Konstantinova NN, Pigina TV. Intrauterine blood transfusion as a method of treatment of the edematous form of hemolytic disease of newborn. Obstetrics and Gynecology. 1990; (7): 41-45. Russian (Михайлов А.В., Константинова Н.Н., Пигина Т.В. Внутриматочные переливания как способ лечения отечной формы гемолитической болезни плода //Акушерство и гинекология. 1990. № 7. C. 41-45)
Liley AW: Intrauterine transfusion of foetus in haemolytic disease. Br Med J. 1963; 2(5365): 1107-1109. doi: 10.1136/bmj.2.5365.1107
Ivanova AV, Zakharova SYu, Kosovtsova NV, Pavlichenko MV, Generalov AE. Specific features of a neonatal period in infants following intrauterine intravascular blood transfusion for fetal hemolytic disease. Rossiyskiy Vestnik Perinatologii i Pediatrii. 2015; 60(1): 44-48. Russian (Иванова А.В., Захарова С.Ю., Косовцова Н.В., Павличенко М.В., Генералов А.Е. Особенности течения неонатального периода у новорожденных, получивших внутриутробное внутрисосудистое переливание крови по поводу гемолитической болезни плода //Российский вестник перинатологии и педиатрии. 2015. Т. 60, № 1. C. 44-48)
Rodeck CH, Kemp JR, Holman CA, Whitmore DN, Karnicki J, Austin MA. Direct intravascular fetal blood transfusion by fetoscopy in severe Rhesus isoimmunisation. Lancet. 1981; 1(8221) :625-627. doi: 10.1016/s0140-6736(81)91549-x
Kravchenko EN, Ozherelieva MA, Kuklina LV, Kropmaer KP, Tsygankova OYu. Perfection of the algorithm for managing pregnant women with rhesus immunization: diagnostic aspects. Mother and Baby in Kuzbass. 2017; 4(71): 43-47. Russian (Кравченко Е.Н., Ожерельева М.А., Куклина JI.B., Кропмаер К.П., Цыганкова О.Ю. Совершенствование алгоритма ведения беременных с резус-иммунизацией: диагностические аспекты //Мать и Дитя в Кузбассе. 2017; 4(71): 43-47)
Sidelnikova V.M. Antonov A.G. Gemoliticheskaya bolezn` ploda i novorozhdennogo. M.: Triada-X, 2004. 191 s. Russian (Сидельникова В.М., Антонов А.Г. Гемолитическая болезнь плода и новорожденного. М.: Триада-Х, 2004. 191 с.)
Bang J, Bock JE, Trolle D. Ultrasound-guided fetal intravenous transfusion for severe rhesus haemolytic disease. Br Med J (Clin Res Ed). 1982; 284(6313): 373-374. doi: 10.1136/bmj.284.6313.373
Vasileva Iu, Poissonier ME. Intrauterine fetal transfusion in twin pregnancy with Rh isoimmunization. Akush Ginekol (Sofiia). 1989; 28(1): 33-6
Manning FA, Bowman JM, Lange IR, Chamberlain PF. Intrauterine Transfusion in an Rh-immunized Twin Pregnancy: A Case Report of Successful Outcome and a Review of the Literature. Obstet Gynecol. 1985; 65(3 Suppl): 2S-6S
Zwiers C, Lindenburg ITM, Klumper FJ, De Haas M, Oepkes D, Van Kamp IL. Complications of intrauterine intravascular blood transfusion: lessons learned after 1678 procedures. Ultrasound Obstet Gynecol. 2017; 50: 180-186. doi: 10.1002/uog.17319
Wu J, Huang L-H, Luo Y-M, Fang Q. Discordant intrauterine transfusion in dichorionic twin pregnancy with Rh isoimmunization. Transfus Apher Sci. 2017; 56(6): 883-885. doi: 10.1016/j.transci.2017.10.007