intrauterine fetal blood transfusion

treatment overview

an intrauterine transfusion provides blood to an rh-positive fetus when fetal red blood cells are being destroyed by the rh-sensitized mother's immune system. this treatment is meant to keep the fetus healthy until the baby is mature enough to be delivered.

transfusions can be given through the fetal abdomen or, more often, by delivering the blood into the umbilical vein or artery.

an intrauterine fetal blood transfusion is done in the hospital. the mother may have to stay overnight after the procedure.

what to expect

a short recovery period (approximately 1 to 3 hours) is needed to allow the mother's sedatives to wear off. if the fetus was given medicine to prevent movement, it may be several hours until the mother can feel the fetus moving again.

why it is done

an intrauterine blood transfusion may be done to replace fetal red blood cells that are being destroyed by an rh-sensitized mother's immune system (rh disease). these transfusions are done when:

• doppler ultrasound of the middle cerebral artery suggests anemia.
• the bilirubin result from amniocentesis testing shows that the fetus is moderately to severely affected by rh sensitization.
• ultrasound shows evidence of fetal hydrops, such as swollen tissues and organs.
• fetal blood sampling (fbs) shows that the fetus has severe anemia. the transfusion may be done right away.

in a severely affected fetus, transfusions are done every 1 to 4 weeks until the fetus is mature enough to be delivered safely.

how well it works

fetal survival after transfusion depends upon the severity of the fetus's illness, the method of transfusion, and the skill of the doctor who does the procedure. overall, after intrauterine transfusion through the umbilical cord:^{footnote 1}

• more than 90% of fetuses that do not have hydrops survive.
• about 75% of fetuses that have hydrops survive.

risks

intrauterine transfusions may cause:

• uterine infection.
• fetal infection.
• preterm labour.
• excessive bleeding and mixing of fetal and maternal blood.
• amniotic fluid leakage from the uterus.
• fetal death.