• Fetal Blood Transfusion

    (Intrauterine Transfusion; IUT; Intraperitoneal Transfusion; IPT)

    Definition

    This procedure is done when a baby that is still in the womb suffers from severe anemia . Anemia is a lack of red blood cells. A transfusion is needed when the baby's blood count falls too low. A transfusion means giving the baby 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’ umbilical cord; more common procedure
    • Intraperitoneal transfusion (IPT)—done through the mother’s abdomen and uterus into the fetus’ abdomen; usually only done if IVT is impossible to do because of the position of the baby and the umbilical cord

    Reasons for Procedure

    Fetal blood transfusions are done because the baby in the womb is suffering from severe anemia and could die without a transfusion. Anemia can be caused by:
    • Rh incompatibility —the mother and baby have a different type of blood, and mother’s antibodies to fetal blood cells lyse (destroy) fetal blood cells.
    • Parvovirus B19 infection —a viral infection in the mother
    • Twin-to-twin transfusion syndrome—can occur in monochorionic (developing in one chorionic sac) twin pregnancies
    The goals of fetal blood transfusions are to:
    • Prevent or treat fetal hydrops before delivery—Hydrops is caused by severe anemia in the fetus. The fetus develops heart failure. This leads to fluid collecting in the skin, lungs, abdomen, or around the heart.
    • Continue the pregnancy so the baby can be born close to term

    Possible Complications

    Possible complications for mother and fetus include:
    • Need for Cesarean section (C-section) due to 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
    • Causing your water to break
    • Graft versus host disease in the fetus (a rare condition in which the donor’s blood cells attack the baby's blood cells)
    Be sure to discuss these risks with your doctor before the procedure.

    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 medicine
    • Muscle relaxant through an injection or an IV

    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' blood level (called hematocrit). 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 baby.

    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 baby or if the procedure is long, the uterus will 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 C-section.

    Post-procedure Care

    The doctor may give you:
    • Antibiotics to prevent infection
    • Medicine 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
    • Congestive heart failure
    • Respiratory failure
    • Other complications if the baby is premature

    Call Your Doctor

    After you leave the hospital, contact 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
    • Water breaks (a sign of labor)
    • Other signs of early labor:
      • Uterine contractions
      • Back pain that comes and goes
      • Vaginal bleeding
    In case of an emergency, call for medical help right away.

    RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/For%5FPatients

    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

    Anderson K, Ness P, eds. Scientific Basis of Transfusion Medicine: Implications for Clinical Practice . 2nd ed. Philadelphia, PA: WB Saunders Company; 2000.

    Behrman R, Kliegman R, Jenson H, eds. Nelson Textbook of Pediatrics . 17th ed. Philadelphia, PA: Elsevier; 2004.

    Creasy R, Resnik R, eds. Maternal-Fetal Medicine . 4th ed. Philadelphia, PA: WB Saunders Company; 1999.

    Gabbe S, Niebyl J, Simpson JL, eds. Normal and Problem Pregnancies . 4th ed. Oxford, UK: Churchill Livingstone, Inc; 2002.

    Gibson BE, Todd A Roberts I, Pamphilon D, 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.

    Harman C, ed. Invasive Fetal Testing and Treatment . Boston, MA: Blackwell Scientific Publications; 1995.

    Kenner C, Wright Lott J, eds. Comprehensive Neonatal Nursing: A Physiologic Perspective . 3rd ed. Philadelphia, PA: Saunders; 2003.

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

    Mintz P, ed. Transfusion Therapy: Clinical Principles and Practice . Baltimore, MD: AABB Press; 1999.

    Nelson N, ed. Current Therapy in Neonatal-Perinatal Medicine 2 . Philadelphia, PA: BC Decker Inc.; 1990.

    Petz L, Kleinman S, Swisher S, et al, eds. Clinical Practice of Transfusion Medicine . 3rd ed. NY: Churchill Livingstone; 1996.

    Reece E, Hobbins J, eds. Medicine of the Fetus and Mother . 2nd ed. Philadelphia, PA: Lippincott-Raven; 1999.

    Rh factor. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/pregnancycomplications/rhfactor.html . Updated April 2006. Accessed December 20, 2012.

    van Kamp I, Klumper F, Oepkes D, 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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