Intrauterine transfusion for the treatment of Hydrops fetalis due to anemia. Case report and literature review
Keywords:
non-immune fetal hydrops, middle cerebral artery, blood transfusion intrauterine
Abstract
OBJECTIVE
Report a case of non-immune fetal hydrops caused by anemia. Also perform a review of the literature on hydrops-associated fetal anemia.
METHODOLOGY
We present the case of a pregnant woman of 30 years old G1P0 with pregnancy of 22 weeks. In ultrasound evaluation, a syndromatic diagnosis of non-immune fetal hydrops caused by anemia was established. Fetal therapy with multiple transfusions was performed, achieving complete resolution of the symptoms and full-term birth. A literature search was performed in PUBMED, MEDLINE, EMBASE, Cochrane Library, including the Mesh terms: (non-immune fetal hydrops, middle cerebral artery, blood transfusion intrauterine).
RESULTS
Product of the non-systematic review with the combination of the terms Mesh mentioned above and with the time filter, 37 articles were selected for the construction of this report. Review articles, protocols, clinical trials and classic articles related to the topic were included.
CONCLUSION
Non-immune fetal hydrops caused by fetal anemia has high mortality without adequate intervention. The knowledge of this pathology allows a timely diagnosis, a complete approach to the binomial and adequately select the fetuses candidates for in utero therapy, impacting favorably, reducing morbidity and mortality. The management of these patients should be carried out in experienced maternal-fetal units
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Disciplines:
materno fetal medicineReferences
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2. Bellini C, Hennekam RC. Non-immune hydrops fetalis: A short review of etiology and pathophysiology. Am J Med Genet Part A. 2012;158 A(3):597–605.
3. Norton ME, Chauhan SP, Dashe JS. Society for maternal-fetal medicine (SMFM) clinical guideline #7: Nonimmune hydrops fetalis. Am J Obstet Gynecol [Internet]. 2015;212(2):127–39. Available from: http://dx.doi.org/10.1016/j.ajog.2014.12.018
4. Bellini C, Hennekam RCM, Fulcheri E, Rutigliani M, Morcaldi G, Boccardo F, et al. Etiology of nonimmune hydrops fetalis: A systematic review. Am J Med Genet Part A. 2009;149(5):844–51.
5. Randenberg A. Nonimmune Hydrops Fetalis Part II: Does Etiology Influence Mortality? Neonatal Netw J Neonatal Nurs [Internet]. 2010;29(6):367–80. Available from: http://dx.doi.org/10.1891/0730-0832.29.6.367%5Cnhttp://neonatalnetwork.metapress.com/content/j0x4867308647qn2/fulltext.pdf
6. Désilets V, Audibert F, Wilson R, Audibert F, Brock JA, Carroll J, et al. Investigation and Management of Non-immune Fetal Hydrops. J Obstet Gynaecol Canada. 2013;35(10):923–36.
7. Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol [Internet]. 2018 Feb;218(2S):S790–S802.e1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29422212
8. Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther [Internet]. 2014;36(2):86–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24457811
9. Hutchison AA, Drew JH, Yu VY, Williams ML, Fortune DW, Beischer NA. Nonimmunologic hydrops fetalis: a review of 61 cases. Obstet Gynecol [Internet]. 1982 Mar;59(3):347–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7078882
10. Randenberg AL. Nonimmune hydrops fetalis part I: etiology and pathophysiology. Neonatal Netw [Internet]. 2010;29(5):281–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20829175
11. Bellini C, Donarini G, Paladini D, Calevo MG, Bellini T, Ramenghi LA, et al. Etiology of non-immune hydrops fetalis: An update. Am J Med Genet Part A. 2015;167(5):1082–8.
12. Abbasi N, Johnson JA, Ryan G. Fetal anemia. Ultrasound Obstet Gynecol. 2017;50(2):145–53.
13. Nicolaides KH, Clewell WH, Mibashan RS, Soothill PW, Rodeck CH, Campbell S. Fetal Haemoglobin Measurement in the Assessment of Red Cell Isoimmunisation. Lancet. 1988;331(8594):1073–5.
14. Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med [Internet]. 2000 Jan 6;342(1):9–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10620643
15. Moise KJ. Prevention of Rhesus (D) alloimmunization in pregnancy. Uptodate [Internet]. 2008;112(1):164–76. Available from: https://www.uptodate.com/contents/prevention-of-rhesus-d-alloimmunization-in-pregnancy?source=see_link
16. McEwan A. Fetal anaemia. Obstet Gynaecol Reprod Med [Internet]. 2015;25(1):22–8. Available from: http://dx.doi.org/10.1016/j.ogrm.2014.10.011
17. Crane J, Mundle W, Boucoiran I, Gagnon R, Bujold E, Basso M, et al. Parvovirus B19 Infection in Pregnancy. J Obstet Gynaecol Canada [Internet]. 2014;36(12):1107–16. Available from: http://dx.doi.org/10.1016/S1701-2163(15)30390-X
18. Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008;22(1):15–29.
19. Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia-diagnosis and management. Am J Obstet Gynecol [Internet]. 2015;212(6):697–710. Available from: http://dx.doi.org/10.1016/j.ajog.2015.01.059
20. Saltzman DH, Frigoletto FD, Harlow BL, Barss VA, Benacerraf BR. Sonographic evaluation of hydrops fetalis. Obstet Gynecol [Internet]. 1989 Jul;74(1):106–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2660040
21. Roberts AB, Mitchell JM, Pattison NS. Fetal liver length in normal and isoimmunized pregnancies. Am J Obstet Gynecol [Internet]. 1989 Jul;161(1):42–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2665498
22. Oepkes D, Meerman RH, Vandenbussche FP, van Kamp IL, Kok FG, Kanhai HH. Ultrasonographic fetal spleen measurements in red blood cell-alloimmunized pregnancies. Am J Obstet Gynecol [Internet]. 1993 Jul;169(1):121–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8333436
23. Oepkes D, Brand R, Vandenbussche FP, Meerman RH, Kanhai HHH. The use of ultrasonography and Doppler in the prediction of fetal haemolytic anaemia: a multivariate analysis. BJOG An Int J Obstet Gynaecol. 1994;101(8):680–4.
24. Moise KJ. Diagnosing Hemolytic Disease of the Fetus — Time to Put the Needles Away? N Engl J Med [Internet]. 2006;355(2):192–4. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMe068071
25. Molina-Giraldo S, Moise KJ. Revisión de tema ALOINMUNIZACIÓN RH: MANEjO ANTEPARTO. REVISIÓN DE LA LITERATURA Antepartum management of rhesus alloimmunisation. A literature review. Rev Colomb Obstet Ginecol [Internet]. 2009;60(3):262–73. Available from: http://www.scielo.org.co/pdf/rcog/v60n3/v60n3a07.pdf
26. Pretlove SJ, Fox CE, Khan KS, Kilby MD. Noninvasive methods of detecting fetal anaemia: a systematic review and meta-analysis. BJOG [Internet]. 2009 Nov;116(12):1558–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19681854
27. Wenstrom KD. Doppler ultrasonography versus amniocentesis to predict fetal anemia: Commentary. Obstet Gynecol Surv. 2006;61(11):703–4.
28. Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: The untold story. Ultrasound Obstet Gynecol. 2005;25(4):323–30.
29. Berry SM, Stone J, Norton ME, Johnson D, Berghella V. Fetal blood sampling. Am J Obstet Gynecol [Internet]. 2013;209(3):170–80. Available from: http://dx.doi.org/10.1016/j.ajog.2013.07.014
30. 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(2):180–6.
31. Rodeck CH, Kemp JR, Holman CA, Whitmore DN, Karnicki J, Austin MA. Direct intravascular fetal blood transfusion by fetoscopy in severe Rhesus isoimmunisation. Lancet (London, England) [Internet]. 1981 Mar 21;1(8221):625–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6110859
32. Moise KJ, Argoti PS. Management and prevention of red cell alloimmunization in pregnancy: A systematic review. Obstet Gynecol. 2012;120(5):1132–9.
33. Van Kamp IL, Klumper FJCM, Oepkes D, Meerman RH, Scherjon SA, Vandenbussche FPHA, et al. Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2005;192(1):171–7.
34. Materno-fetal SDM. Guia Clínica : :4–7.
35. van Kamp IL, Klumper FJCM, Bakkum RSLA, Oepkes D, Meerman RH, Scherjon SA, et al. The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol [Internet]. 2001 Sep;185(3):668–73. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0002937801313728
36. Selbing A, Stangenberg M, Westgren M, Rahman F. Intrauterine intravascular transfusions in fetal erythroblastosis: The influence of net transfusion volume on fetal survival. Acta Obstet Gynecol Scand [Internet]. 1993 Jan;72(1):20–3. Available from: http://doi.wiley.com/10.3109/00016349309013343
37. Hermann M, Poissonnier MH, Grangé G. Cerebral Doppler velocimetry to predict fetal anemia after more than three intravenous fetal exchange transfusions. Transfusion. 2014;54(11):2968–73.
2. Bellini C, Hennekam RC. Non-immune hydrops fetalis: A short review of etiology and pathophysiology. Am J Med Genet Part A. 2012;158 A(3):597–605.
3. Norton ME, Chauhan SP, Dashe JS. Society for maternal-fetal medicine (SMFM) clinical guideline #7: Nonimmune hydrops fetalis. Am J Obstet Gynecol [Internet]. 2015;212(2):127–39. Available from: http://dx.doi.org/10.1016/j.ajog.2014.12.018
4. Bellini C, Hennekam RCM, Fulcheri E, Rutigliani M, Morcaldi G, Boccardo F, et al. Etiology of nonimmune hydrops fetalis: A systematic review. Am J Med Genet Part A. 2009;149(5):844–51.
5. Randenberg A. Nonimmune Hydrops Fetalis Part II: Does Etiology Influence Mortality? Neonatal Netw J Neonatal Nurs [Internet]. 2010;29(6):367–80. Available from: http://dx.doi.org/10.1891/0730-0832.29.6.367%5Cnhttp://neonatalnetwork.metapress.com/content/j0x4867308647qn2/fulltext.pdf
6. Désilets V, Audibert F, Wilson R, Audibert F, Brock JA, Carroll J, et al. Investigation and Management of Non-immune Fetal Hydrops. J Obstet Gynaecol Canada. 2013;35(10):923–36.
7. Figueras F, Caradeux J, Crispi F, Eixarch E, Peguero A, Gratacos E. Diagnosis and surveillance of late-onset fetal growth restriction. Am J Obstet Gynecol [Internet]. 2018 Feb;218(2S):S790–S802.e1. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29422212
8. Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther [Internet]. 2014;36(2):86–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24457811
9. Hutchison AA, Drew JH, Yu VY, Williams ML, Fortune DW, Beischer NA. Nonimmunologic hydrops fetalis: a review of 61 cases. Obstet Gynecol [Internet]. 1982 Mar;59(3):347–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7078882
10. Randenberg AL. Nonimmune hydrops fetalis part I: etiology and pathophysiology. Neonatal Netw [Internet]. 2010;29(5):281–95. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20829175
11. Bellini C, Donarini G, Paladini D, Calevo MG, Bellini T, Ramenghi LA, et al. Etiology of non-immune hydrops fetalis: An update. Am J Med Genet Part A. 2015;167(5):1082–8.
12. Abbasi N, Johnson JA, Ryan G. Fetal anemia. Ultrasound Obstet Gynecol. 2017;50(2):145–53.
13. Nicolaides KH, Clewell WH, Mibashan RS, Soothill PW, Rodeck CH, Campbell S. Fetal Haemoglobin Measurement in the Assessment of Red Cell Isoimmunisation. Lancet. 1988;331(8594):1073–5.
14. Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med [Internet]. 2000 Jan 6;342(1):9–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10620643
15. Moise KJ. Prevention of Rhesus (D) alloimmunization in pregnancy. Uptodate [Internet]. 2008;112(1):164–76. Available from: https://www.uptodate.com/contents/prevention-of-rhesus-d-alloimmunization-in-pregnancy?source=see_link
16. McEwan A. Fetal anaemia. Obstet Gynaecol Reprod Med [Internet]. 2015;25(1):22–8. Available from: http://dx.doi.org/10.1016/j.ogrm.2014.10.011
17. Crane J, Mundle W, Boucoiran I, Gagnon R, Bujold E, Basso M, et al. Parvovirus B19 Infection in Pregnancy. J Obstet Gynaecol Canada [Internet]. 2014;36(12):1107–16. Available from: http://dx.doi.org/10.1016/S1701-2163(15)30390-X
18. Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008;22(1):15–29.
19. Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: The fetus at risk for anemia-diagnosis and management. Am J Obstet Gynecol [Internet]. 2015;212(6):697–710. Available from: http://dx.doi.org/10.1016/j.ajog.2015.01.059
20. Saltzman DH, Frigoletto FD, Harlow BL, Barss VA, Benacerraf BR. Sonographic evaluation of hydrops fetalis. Obstet Gynecol [Internet]. 1989 Jul;74(1):106–11. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2660040
21. Roberts AB, Mitchell JM, Pattison NS. Fetal liver length in normal and isoimmunized pregnancies. Am J Obstet Gynecol [Internet]. 1989 Jul;161(1):42–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2665498
22. Oepkes D, Meerman RH, Vandenbussche FP, van Kamp IL, Kok FG, Kanhai HH. Ultrasonographic fetal spleen measurements in red blood cell-alloimmunized pregnancies. Am J Obstet Gynecol [Internet]. 1993 Jul;169(1):121–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8333436
23. Oepkes D, Brand R, Vandenbussche FP, Meerman RH, Kanhai HHH. The use of ultrasonography and Doppler in the prediction of fetal haemolytic anaemia: a multivariate analysis. BJOG An Int J Obstet Gynaecol. 1994;101(8):680–4.
24. Moise KJ. Diagnosing Hemolytic Disease of the Fetus — Time to Put the Needles Away? N Engl J Med [Internet]. 2006;355(2):192–4. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMe068071
25. Molina-Giraldo S, Moise KJ. Revisión de tema ALOINMUNIZACIÓN RH: MANEjO ANTEPARTO. REVISIÓN DE LA LITERATURA Antepartum management of rhesus alloimmunisation. A literature review. Rev Colomb Obstet Ginecol [Internet]. 2009;60(3):262–73. Available from: http://www.scielo.org.co/pdf/rcog/v60n3/v60n3a07.pdf
26. Pretlove SJ, Fox CE, Khan KS, Kilby MD. Noninvasive methods of detecting fetal anaemia: a systematic review and meta-analysis. BJOG [Internet]. 2009 Nov;116(12):1558–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19681854
27. Wenstrom KD. Doppler ultrasonography versus amniocentesis to predict fetal anemia: Commentary. Obstet Gynecol Surv. 2006;61(11):703–4.
28. Mari G. Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: The untold story. Ultrasound Obstet Gynecol. 2005;25(4):323–30.
29. Berry SM, Stone J, Norton ME, Johnson D, Berghella V. Fetal blood sampling. Am J Obstet Gynecol [Internet]. 2013;209(3):170–80. Available from: http://dx.doi.org/10.1016/j.ajog.2013.07.014
30. 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(2):180–6.
31. Rodeck CH, Kemp JR, Holman CA, Whitmore DN, Karnicki J, Austin MA. Direct intravascular fetal blood transfusion by fetoscopy in severe Rhesus isoimmunisation. Lancet (London, England) [Internet]. 1981 Mar 21;1(8221):625–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6110859
32. Moise KJ, Argoti PS. Management and prevention of red cell alloimmunization in pregnancy: A systematic review. Obstet Gynecol. 2012;120(5):1132–9.
33. Van Kamp IL, Klumper FJCM, Oepkes D, Meerman RH, Scherjon SA, Vandenbussche FPHA, et al. Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2005;192(1):171–7.
34. Materno-fetal SDM. Guia Clínica : :4–7.
35. van Kamp IL, Klumper FJCM, Bakkum RSLA, Oepkes D, Meerman RH, Scherjon SA, et al. The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol [Internet]. 2001 Sep;185(3):668–73. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0002937801313728
36. Selbing A, Stangenberg M, Westgren M, Rahman F. Intrauterine intravascular transfusions in fetal erythroblastosis: The influence of net transfusion volume on fetal survival. Acta Obstet Gynecol Scand [Internet]. 1993 Jan;72(1):20–3. Available from: http://doi.wiley.com/10.3109/00016349309013343
37. Hermann M, Poissonnier MH, Grangé G. Cerebral Doppler velocimetry to predict fetal anemia after more than three intravenous fetal exchange transfusions. Transfusion. 2014;54(11):2968–73.
How to Cite
(1)
Hincapié-Porras, C.; Rojas-Arias, J. L.; Acuña-Osorio, E. M.; Avellaneda-Salamanca , A. C.; Pinto-Quiñonez, M. L.; Molina-Giraldo, S. Intrauterine Transfusion for the Treatment of Hydrops Fetalis Due to Anemia. Case Report and Literature Review. Rev. Fac. Cienc. Salud Univ. Cauca 2020, 22, 50-59.
Published
2020-07-01
Section
Reportes de caso
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