Intracardiac fetal therapy: report of the first successful fetal cardiac intervention in Peru, with postnatal correlation at birth and 18 months of life

• Autores: Gil Guevara, Enrique, Diez Chang, Guillermo, Miranda Frisancho, Braowell, Pérez, Ina, Bazán, Carlos, Muñoz Acosta, Jairo, Gonzales Carrillo, Oswaldo
• Formato: artículo
• Fecha de Publicación: 2024
• Institución: Sociedad Peruana de Obstetricia y Ginecología
• Repositorio: Revista Peruana de Ginecología y Obstetricia
• Lenguaje: español; inglés
• OAI Identifier: oai:ginecologiayobstetricia.pe:article/2607
• Enlace del recurso: https://ginecologiayobstetricia.pe/index.php/RPGO/article/view/2607
• Nivel de acceso: acceso abierto
• Materia: Anemia; fetal; Rh isoimmunization; Fetal heart intervention; Blood transfusion; intracardiac; Anemia fetal; Isoinmunización Rh; Corazón fetal; intervención; Transfusión sanguínea; intracardiaca

Fetal anemia is a cause of perinatal morbidity and mortality. Although it has differentetiologies and despite the introduction of RhD immunoglobulin prophylaxis,alloimmunization remains one of its main causes. These pregnancies are initiallyidentified by measuring in the fetus the middle cerebral artery peak systolic velocity(MCA-PSV) and moderate to severe anemia should be suspected when the MCA-PSVis ≥1.50 multiples of the median. In these cases, the actual hematocrit is determinedby obtaining fetal blood. Intervention with a fetal hemoglobin no lower than 7g/dL results in a better fetal outcome compared to waiting until the development ofsevere anemia <5g/dL or hydrops. Intravascular fetal transfusion is preferable tointraperitoneal transfusion due to higher survival rates, particularly of hydropicfetuses. The umbilical vein is the preferred vascular site due to ease of access andgreater safety compared to other vascular sites. Direct cardiac puncture is rarelyperformed because of an increased risk of serious complications, including fetaldeath. In the present article we present the first case reported in our country ofintracardiac transfusion in a fetus with severe anemia due to Rh isoimmunization,which had an exhaustive and difficult management, but with an excellent subsequentfetal, neonatal and postnatal evolution.