Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 96

Over the last 15 years, reported survival rates for intrauterine fetal transfusion for red cell alloimmunization have improved to over 90% in expert hands. Survival rates for parvovirus infection are lower, in the 70–80% range, likely related to late diagnosis in many cases. In the largest series to date of fetal intravascular transfusion, procedure‐related complications have decreased over time, from 9.8% to 3.3% per fetus. The two most common complications of fetal transfusion in this series were fetal demise and fetal distress leading to emergency cesarean delivery. Fetal distress may occur due to cord trauma or volume overload related to the procedure itself. Delayed complications include chorioamnionitis, premature rupture of membranes, and preterm labor but these are extremely rare. Needling of a free loop of cord, inadvertent arterial puncture, and failure to use fetal paralysis are all associated with higher rates of procedural complications. Nonetheless, procedure‐related fetal demise decreased over time in this large series of 1678 transfusions, from 1.6% to 0.6% per procedure. Associated risk factors for fetal loss include presence of fetal hydrops, early gestational age at first transfusion, and limited operator experience.