Turhan ARAN, Mehmet A. OSMANAĞAOĞLU, İpek PEKGÖZ, Hasan BOZKAYA

Erken Başlangıçlı Maternal Rh İzoimmunizasyonu Nedenli Fetal Hidrops Olgusunun Başarılı Yönetimi; Olgu Sunumu

Amaç: Rh izoimmünizasyonu nedenli fetal hidrops olgusunun başarılı yönetimini sunmak ve erken ikinci trimester fetal eritrosit transfüzyonu tekniğini tartışmak. Olgu: 36 yaşında immünize Rh tanılı hasta hastanemiz perinatoloji ünitesine hidrops fetalis ön tanısı ile sevk edilmişti. Öyküsünde hidrops fetalis nedeni ile üç gebelik kaybı mevcuttu. Yapılan obstetrik doppler ultrasonografide orta serebral arter pik sistolik akım hızı 1.5 MoM dan daha yüksek idi. Fetal anemi ön tanısı ile kordosentez uygulandı. Fetal hemoglobin 3 gr/ dl idi. Eş zamanlı olarak intrauterin fetal eritrsoit transfüzyonu yapıldı. Şiddetli fetal anemi nedeni ile hedeflen fetal hematokrit düzeyine 1 hafta sonra yapılan ikinci transfüzyonla ulaşıldı. 24. 27. ve 31. gebelik haftalarında tekrar transfüzyon uygulanan hastaya 35. gebelik haftasının tamamlanmasından sonra eski sezaryen endikayonu ile elektif şartlarda sezaryen yapıldı. 2330 gram ağırlığında 9/10 APGAR' lı yenidoğan doğurtuldu. Sezaryen sırasında alınan kordon kanı hemoglobini 8.7gr/dl idi. Postpartum 2. saatte exchange transfüzyon yapıldı. Yenidoğanın postpartum 3. ve 7. gün kraniyal MRI incelemelerinde de özellik saptanmadı. Nörolojik muayenesinde ve işitme tarama testinde özellik saptanmayan yenidoğan şifa ile taburcu edildi. Sonuçlar: Erken ikinci trimester fetal intravenöz eritrosit transfüzyonu teknik olarak zordur. Şiddetli fetal anemi olgularında hemodinamik instabiliteye neden olmamak ve mortaliteyi arttırmamak için istenilen hematokrit düzeyine aralıklı iki transfüzyonla ulaşılması akılda bulundurulmalıdır.

Successful Management of Hydrops Fetalis Due to Maternal rh Alloimmunization at early Second trimester: case report

Aim: to present a successfully managed fetal hydrops case due to maternal Rh alloimmunization and discuss early second trimester fetal red blood cell transfusion technique. Case: A Thirty-six year old woman with immunized Rh and fetal hydrops was assessed at our perinatology department. There were three previous pregnancy losses because of fetal hydrops in her obstetric history. In obstetric doppler scan, fetal middle cerebral artery peak systolic velocity was greater than 1.5 MoM. Cordosynthesis was offered to family. Fetal haemoglobin was 3gr/dl. Concomitant red blood cell transfusion was performed due to severe fetal anemia. We planned to reach targeted hematocrit level with two transfusions in a week interval. Repeated transfusions were performed at 24th, 27th and 31st week. 2330 gr. neonate with 9/10 APGAR was delivered with cesarean section. Hemoglobin concentration of newborn was 8.7gr/dl at time of delivery. Postpartum cranial MRI scanning and neurological findings were unremarkable. Healthy newborn was discharged. Conclusion: Early second trimester fetal red blood cell transfusion was technically difficult. Reaching targeted hematocrit level with interval transfusions should be kept in mind in severely anemic fetuses because early second trimester transfusion may cause fetal hemodynamic alterations and fetal death

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