Torbjorn moe eggboe_transfusions_norway

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NNFM Nordic Network of Fetal Medicine

Torbjorn Moe Eggboe, NNFM Nordic Network of Fetal Medicine meeting in Gothenburg 14-16th of April 2015.

Healthcare

TorbjørnEggebø
NationalCenter
forFetalMedicine
DeptOb&Gyn
Trondheim-Norway
Organisationofinvasivefetal
medicineinNorway

Deliveries
! 60000/year
! Onlyriskgroupsareoffered1trimester
examination
" >38years
! Routineexaminationinsecondtrimester

Fetalmedicinecenters
! Oslo(CVS)
! Bergen(CVS)
! Trondheim(CVS)
! Stavanger
! Tromsø(CVS)

Nationalcenterforfetalmedicine–
established1990
1. Nationalresponsibilityforinvasive
procedureswithhighriskforthe
fetus(e.g.transfusions)
TTSarereferredabroad
2.Centerofcompetenceforfetal
medicine

NCFM
! High-riskprenatalinvasiveprocedureslikeintrauterine
transfusionsanddrainageoffetaleffusionsarecentralized
totheNationalcenterforfetalmedicine(NSFM)
! Thecenterisalsoareferralcenterforfetuseswithsevere
orunclearmalformations
! Allinvasiveproceduresandfetalmalformationsare
recordedinaqualityregistryusedforqualityassurance
andresearch
! NCFMteachesandtrainsmidwivesanddoctorsin
ultrasounddiagnostics
! IncooperationwiththeNorwegianUniversityinTechnology
(NTNU),thecenterdevelopsnewproceduresand
technologiesinfetalmedicine
! ThecenterisaWHOcollaboratingcenterfordiagnostic
ultrasoundinobstetricsandgynecology

1988:rhesusnegative
Gravida6,para3,alive1
YearDeliveryOutcome
o 1973Vaginaldelivery2840g,healthy(noanti-D
prophylaxis)
o 1975VaginaldeliveryStillbirth,erythroblastosis
o 1975CSNeonataldeathafter1day
o 1983Miscarriage
o 1985Ectopicpregnancy
 1988CS,32weeks5fetaltransfusions;1600g
FirstfetaltransfusioninNorway

Etiologyoffetalanemiainfetusestreatedwith
bloodtransfusionsatNCFMfrom1988to2007
1988–2007
N=101
Rhesus-D
69%
Parvovirus
11%
Rhesus-E
2%
Kell2%
Thalassemia2%
Hemoglobinopathia1%
CMV1%
Notknown
12%

Anti-bodies
thatmaycause
fetalanemia
Anti-D
Anti-c
Anti-E
AntiKell
AntiFya(Duffy)rarely(titer>64)
Trondheim
94%
Anti-D

MCA
MCA
ACAAbas
1995
Anemicfetuses!highpeakvelocities

MCApeakvelocityin111fetusesatriskforanemia
162024283236weeks
MCA-PV (cm/sec)
90
50
40
30
20
10
60
70
80
100
1.50
median
Marietal.,NEnglJMed2000
MoMAnemiawithhydrops
ΔAnemiawithouthydrops
oNoanemia

Redcellalloimmunisation
Surveillancetoday
! Obstetrichistory
! Antibodylevels(titres)
! DopplerofArteriacerebrimedia
! Fetalbloodsamplingandtransfusion

MCAPVandEVF
0
10
20
30
40
50
60
70
80
90
100
110
152025303540
Gestationalage(weeks) MCA PV cm/sec
MCAPVwhenEVF<25
MCAPVwhenEVF25-34
MCAPVwhenEVF>34
Linear(MCAPVwhenEVF<25)
Linear(MCAPVwhenEVF25-34)
Linear(MCAPVwhenEVF>34)
CorrelationofMCAPVtoEVF
Trondheim2000-2006
n=66
n=96
n=159
N=321

Medianand1.5multiplesofthemedian
ofMCAduringpregnancyMarietal.
Fetalblood
sampling
Transfusion

MCVPVandEVFbeforeandafterfirsttransfusion
Trondheim
N=27
EVFbeforetransfusion
EVFaftertransfusion
MCVPVbeforetransfusion
MCVPVaftertransfusion

Hematocritpriortofirsttransfusionandhydrops
N=74
hydrops
without
hydrops

Numberoffetuses(n=74)treatedfor
redcellalloimmunizationperyearatNCFM

Invasiveprocedures
(2008-14)
2008200920102011201220132014
Anemia7(35)3(21)2(8)2(7)7(39)6(35)5(16)

March2014
! RhD-women
! Antibodiesinfirsttrimester
! FreefetalDNA(RHD)inweek25
! anti-Dimmunoglobulininweek29
(fetus+)
! Testingofchildafterdelivery

2016
! Twoexperienceddoctorswill
retireinDecember2015
! Oneofthemwillstillbeavailable
forinvasiveprocedures
! Twonewdoctorstrained

Legalterminations
Womandecidesupto12+0
Abortioncouncilfrom12-21+6
malformations
socialindications
Fromweek22itisnotallowed
Exceptions–deadlymalformations
maternalindications

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