Features of the course and outcomes of pregnancy in Rhesus isoimmunization. The experience of intrauterine blood transfusion in Rhesus isoimmunization

Objective. Analysis of the course and outcomes of pregnancy in patients with Rhesus isoimmunization after intrauterine blood transfusion. Materials and methods. 169 pregnant women with Rhesus conflict were examined on the basis of the Moscow Regional Scientific Research Institute of Obstetrics and Gynecology named after Academician V.I. Krasnopolsky. A standard examination and ultrasound monitoring of the indicators in the average cerebral artery were performed every 1—2 weeks at a gestation period of more than 20 weeks. According to Dopplerometry, 46 (27.2%) patients had ultrasound signs of severe fetal anemia, which required intrauterine blood transfusion (IUBT), which was performed between the 23rd and 36th weeks of pregnancy. Results. One IUBT was conducted by 23 (50%) patients. In this group, the duration of surgery ranged from 26.5 to 35.1 weeks of gestation. The average delivery time was 36.4 weeks. After surgery, pregnancy was prolonged in 19 (82.6%) women by an average of 21.4 days. IUBT was performed twice in 18 (39.1%) pregnant women. In this group, this operation was performed from the 23.2th to the 32.3th week of gestation. The average delivery time was 34.6 weeks. It was possible to prolong pregnancy after the second IUBT by an average of 16.1 days. IUBT was performed three times in 2 (4.3%) pregnant women at a gestation period of 26.4—32.3 weeks. Pregnancy was prolonged after the third by an average of 16.5 days. Both patients were delivered prematurely by abdominal surgery as planned due to the progression of fetal hemolytic disease at 31.2 and 36 weeks, respectively. In pregnant women who underwent IUBT 4 times (three patients — 6.5%), this operation was performed during the gestation period of 24.5—32.3 weeks. After the fourth IUBT, pregnancy was prolonged by an average of 17.3 days. All patients were delivered as planned by abdominal delivery at gestation periods of 33.3, 35.1 and 34.2 weeks. Conclusion. Repeated IUBT makes it possible to prolong pregnancy and reduce the likelihood of having deeply premature babies, and undoubtedly improves perinatal outcomes.