213: Is intrauterine exchange transfusion a safe procedure for management of severe fetal anemia?

To study modalities and complications of intrauterine exchange transfusion (IUET) as management of severe fetal anemia. Retrospective study including all procedures performed between January 1999 and January 2012 in our regional center. Characteristics of each IUET were studied to identify risk factors for complications. Survival rate according to the different etiologies of anemia was evaluated. 225 IUET were performed in 96 fetuses. Major indications were feto-maternal erythrocyte alloimmunization (n=80/96; 83,3%) and parvovirus B19 infection (n=13/96; 13.5%). 26% of the fetuses (25/96) had hydrops fetalis before first intrauterine procedure. Mean number of needle insertions during IUET was 1.34 ± 0.7, needle was displaced in 21.7% of procedures, hemorrhage at needle insertion site occurred in 42.6% of cases and fetal bradycardia in 4% of them. Intrauterine fetal death occurred after 2.7% of procedures (6/225), premature rupture of the membranes after 0.9% (2/225) and emergency cesarean section delivery after 3.6% (8/225). Fetal bradycardia (p. <0.01; OR 37; 95% CI, 8.3 to 170) and gestational age up to 32 weeks (p. = 0,038; OR 3.67; 95% CI, 1.07 to 12.58) were significantly related to complications after procedure. Complication rate was 17.7% of all pregnancies (17/96) and 7.5% of performed procedures (17/225). Overall survival rate in our cohort was 87,5% (84/96), 90% (72/80) in the alloimmunization group and 76.9% (10/13) in the parvovirus infected group (NS). Intrauterine exchange transfusion procedures result in a non-negligible complication rate and thus should be performed by well-trained and specialized professionals.