Effect of intravenous immunoglobulins to postpone the gestational age of first intrauterine transfusion in very severe red blood cell alloimmunization: A case-control study - 16/03/21

Doi : 10.1016/j.jogoh.2021.102119

Emeline Maisonneuve ^a,^b,⁎ , Anaïs Dugas ^a, Stéphanie Friszer ^a,^b, Cécile Toly-Ndour ^c, Laura Cariot ^a, Ferdinand Dhombres ^a,^d, Anne Cortey ^a,^b, Agnès Mailloux ^c, Bruno Carbonne ^e, Jean-Marie Jouannic ^a,^b,^d
^a Fetal Medicine department, Armand-Trousseau Hospital, 26, avenue du Dr Arnold netter, 75012, Paris, France
^b Clinical Unit of CNRHP: Centre National de Référence en Hémobiologie Périnatale, Armand-Trousseau Hospital, 26, avenue du Dr Arnold netter, 75012, Paris, France
^c Biological Unit of CNRHP: Centre National de Référence en Hémobiologie Périnatale, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, Paris, France
^d Sorbonne Université, Paris, France
^e Obstetrics and Gynecology Department, Princesse Grace Hospital, 1, avenue Pasteur, 98000, Monaco

^⁎Corresponding author at: Fetal Medicine, Armand-Trousseau Hospital, 26, avenue du Dr Arnold Netter, 75012, Paris, France.Fetal MedicineArmand-Trousseau Hospital26, avenue du Dr Arnold NetterParis75012France

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Abstract

BACKGROUND

Early intrauterine transfusion (IUT) is associated with a higher risk of fetal loss. Our objective was to evaluate the efficiciency of intravenous immunoglobulins (IVIG) to postpone the gestational age at first IUT beyond 20 weeks of gestation (WG) compared to the previous pregnancy in case of very severe red blood cell (RBC) alloimmunization.

STUDY DESIGN AND METHODS

Very severe RBC alloimmunization was defined by a high titer of antibodies and a previous pregnancy complicated by a first IUT before 24 W G and/or perinatal death directly related to alloimmunization.

We performed a single-center case-control study. Cases and controls were patients respectively treated with weekly IVIG infusions started before 13 W G, and without.

RESULTS

Twenty cases and 21 controls were included. Gestational age (GA) at first IUT was postponed after 20 W G in 18/20 (90%) of patients treated with IVIG and in 15/21 (71%) in the control group (p = 0.24). Compared to the previous pregnancy, the GA at first IUT was postponed by a median of 22 [+11; +49] days in the IVIG group and occurred in average 2 days earlier [-17 ; +12] in the non-treated group (p = 0.02). There was no difference between number of IUT and need for exchange-transfusion. IVIG treatment was associated with a significant decrease of antibodies' quantitation.

CONCLUSION

In our series, IVIG tends to differ first IUT beyond 20 W G and have a significant effect in postponing the gestational age of the first IUT in patients with very severe RBC alloimmunization.

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Keywords : Very severe RBC alloimmunization, Fetal anemia, Intrauterine transfusion, Intravenous Immunoglobulins, Hemolytic Disease of the Fetus and Newborn