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Fetal Blood Transfusion

(Intrauterine Transfusion; IUT; Intraperitoneal Transfusion; IPT)

Definition

This procedure is done when a fetus suffers from severe anemia . Anemia is a lack of red blood cells. A transfusion means giving the fetus red blood cells from a donor.
There are two types of fetal blood transfusions:
  • Intravascular transfusion (IVT)—done through the mother’s abdomen into the fetus’s umbilical cord
  • Intraperitoneal transfusion (IPT)—done through the mother’s abdomen and uterus into the fetus’s abdomen; usually only done if IVT is impossible to do because of the position of the fetus and the umbilical cord

Reasons for Procedure

A transfusion is needed when the fetus's blood count falls too low. Severe anemia in a fetus can cause death. Anemia can be caused by:
  • Rh incompatibility —the mother and fetus have a different type of blood, and mother’s antibodies to fetal blood cells destroy fetal blood cells
  • Parvovirus B19 infection —a viral infection in the mother
  • Twin-to-twin transfusion syndrome—can occur in twin pregnancies where development is in one chorionic sac
The goals of fetal blood transfusions are to:
  • Prevent or treat fetal hydrops before delivery—Hydrops is caused by severe anemia in the fetus, which develops into heart failure. This leads to fluid collecting in the skin, lungs, abdomen, or around the heart.
  • Continue the pregnancy so the fetus can be born close to term

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like:
  • Need for cesarean section because of fetal distress after the procedure
  • Premature rupture of membranes and/or premature labor
  • Abdominal bruising or soreness
  • Bleeding, cramping, or leaking fluid from vagina
  • Infection
  • Injury to the fetus
  • Giving too much blood
  • Fetal bleeding
  • A rare condition in which the donor’s blood cells attack the fetus's blood cells

What to Expect

Prior to Procedure

The doctor may do tests to see if the fetus has severe anemia or fetal hydrops.
The doctor may need to examine body fluids. This can be done with:
Your doctor may need pictures of your abdomen. This can be done with ultrasound .
Amniocentesis
Amniocentesis
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If the fetus has hydrops, the blood transfusion will be done right away.
Before the transfusion, you may be given:
  • Pain medication
  • Medication to help you relax

Anesthesia

Local anesthesia numbs a small area of your abdomen.

Description of the Procedure

With IVT, the fetus will be paralyzed for a short time. This is to allow access to fetal blood vessels and to reduce injury to the fetus. During both IVT and IPT, the doctor will monitor the fetus with an ultrasound scan. The ultrasound will:
  • Show the position of the fetus
  • Guide the placement of the needle through the amniotic sac and into the vessel in the umbilical cord
  • Record the fetal heart rate
The doctor will insert a needle into your abdomen. Using ultrasound, the doctor will make sure the needle is placed correctly. The needle will go through your abdomen and be inserted into the umbilical cord (IUT) or into the fetal abdomen (IPT). Blood will be transfused to the fetus.
Before the needle is removed, the doctor will take a final blood sample. This is to determine the fetus's blood level. The doctor will find out whether the transfusion was enough and when the next one should be.
The transfusions may need to be repeated every 2-4 weeks until your doctor decides that it is safe to deliver the fetus.

How Long Will It Take?

A 10 ml IVT transfusion will take 1-2 minutes. Usually, between 30-200 ml is transfused during a single procedure.

How Much Will It Hurt?

You will feel pain and cramping where the doctor inserts the needle. If you are close to delivering the fetus or if the procedure is long, the uterus can be sore.

Average Hospital Stay

This procedure is done in a hospital setting. You will be able to go home after the transfusion. If complications occur, you may need to have a cesarean section.

Post-procedure Care

The doctor may give you:
  • Antibiotics to prevent infection
  • Medication to prevent contractions or labor
Be sure to follow your doctor’s instructions.
After your baby has been delivered, the baby will need to have follow-up blood tests. The doctor will closely monitor the baby for:
  • Anemia
  • Liver damage
  • Heart failure
  • Respiratory failure
  • Other complications if the baby is premature

Call Your Doctor

Call your doctor if any of the following occurs:
  • Signs of infection, including fever or chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the needle insertion site
  • You are not feeling your baby moving normally
Know the signs of early labor:
  • Water breaks
  • Uterine contractions
  • Back pain that comes and goes
  • Vaginal bleeding
If you think you have an emergency, call for medical help right away.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org

American Pregnancy Association http://www.americanpregnancy.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

Gibson BE, Todd A, et al. British Committee for Standards in Haematology Transfusion Task Force: Writing group. Transfusion guidelines for neonates and older children. Br J Haematol . 2004; 124: 433-453.

Management of Isoimmunization in Pregnancy. ACOG Educational Bulletin . No. 227. August 1996.

Rh factor. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/rhfactor.html . Updated April 2006. Accessed June 10, 2013.

van Kamp I, Klumper F, et al. Complications of intrauterine intravascular transfusion of fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol . 2005;192:171-177.

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