EP10.28: Management of severe fetal anemia with intrauterine transfusion in Hungary: the first steps

Our aim is to present our initial cases of intrauterine transfusion at a tertiary centre in Budapest. Severe fetal anemia is an underdiagnosed condition, which in untreated cases often leads to hydrops, long term myocardial and cerebellar ischemia or even fetal demise. Correct evaluation of middle cerebral artery peak systolic velocity (MCA PSV) value by expert ultrasound examination and fetal blood transfusion performed at the appropriate time based on this result can prevent adverse fetal and neonatal outcome. This study summarises our results of the newly introduced procedure, intrauterine transfusion (IUT) at the Department of Obstetrics and Gynecology of Semmelweis University between November 2023 and March 2024. We performed intrahepatic venous and umbilical venous transfusion depending on fetal and placental position. A total of 7 IUTs were performed in case of 5 patients during the study period. The indication of IUT was red-blood cell isoimmunisation in five cases (n = 5, 71,43%) and parvo B19 or CMV infections in the remaining two (n = 2, 28.57%). Among them, intrahepatic approach was performed in the vast of majority cases (n = 4, 57,1%), which is the preferred method considering the complication rate. In 6 cases the parents decided to continue the pregnancy following the procedure, where we could prolong the time spent in utero, thereby improving the chances of survival for the fetus and newborn. During a short period of time our group managed to successfully perform 7 interventions, which is groundbreaking in Hungary. The procedure definitely improves perinatal outcome, extends the duration of pregnancy, lowers the rate of intrauterine death and iatrogen premature birth, thus relieving the burden on the healthcare system. However more interventions and further studies with long-term follow-up will be required to assess the effectiveness of IUT.