Intrauterine Fetal Blood Transfusion

An intrauterine fetal blood transfusion involves giving a baby that is still in utero red blood cells from a compatible donor. This is done when a baby suffers from severe anemia, which is an inadequate number of quality red blood cells in the fetal circulatory system. Red blood cells carry oxygen to the cells and organs within the body so anemia can cause a variety of complications, some that can be fatal.

  1. Rh incompatibility, where the mother and baby have a different type of blood and the other’s antibodies destroy the fetal blood cells.
  2. An infection in the mother caused by the parvovirus B19.
  3. Anemia caused by other factors, such as abnormal red blood cells.
  1. To prevent or treat hydrops fetalis, which is the abnormal accumulation of fluid in at least two fetal compartments, such as the skin, lungs, abdomen, and around the heart. It can be caused by severe anemia in utero and lead to heart failure.
  2. To continue the pregnancy for as long as possible so the baby is born at term.
  1. The doctor may carry out tests to see if the fetus is severely anemic and/or if they are suffering from hydrops. This may be done using ultrasound along with cordocentesis, where blood is drawn from the umbilical cord and tested. If hydrops fetalis is diagnosed, blood transfusion is the appropriate treatment and should be carried out immediately.
  2. The doctor will schedule the donor for blood donation to prepare the blood for transfusion. The blood should not be older than 72 hours.
  3. The donor must stop all blood-thinning medication before the procedure. Aspirin and medication containing aspirin must be stopped at least five days before the donation while heparin or Lovenox must be stopped 24 hours before.
  1. You will need to sign all relevant consent forms and empty your bladder before the transfusion.
  2. You will lie on a bed and be given pain medication, a sedative to help you relax, and local anesthesia that will be administered to your abdomen.
  3. Ultrasound will be used before, during, and after the procedure to monitor the fetus and to locate the blood vessels of the umbilical cord.
  4. The doctor will insert a needle through your abdomen and into the umbilical cord to the first draw blood from the fetus to run a complete blood panel (CBC) to determine how much blood the fetus needs.
  5. The doctor will then administer medication to the fetus to slow their movement to reduce the risk of complications during the procedure.
  6. The transfusion will be carried out. After the procedure, blood will be drawn from the fetus once again for further treatment planning as appropriate.
  1. You will remain in the hospital for two to three hours after the procedure. If complications arise, a Cesarean may be necessary.
  2. You will be given antibiotics to prevent infection and medication to prevent uterine contractions.
  3. Most pregnant women find the procedure slightly uncomfortable. Some experience uterine contractions when the needle is inserted, but these tend to stop on their own. Some experience pain at the insertion site for hours up to a few days after the procedure.
  • Do not fly for at least 72 hours after the procedure.
  • Avoid long-distance travel within the first week after the procedure.
Intrauterine fetal blood transfusion is a difficult procedure with the risk of complications at every step. Your doctor will carefully consider these risks and do everything possible to prevent them. Possible complications include:
  1. Fetal distress.
  2. Premature rupture of membranes and/or preterm labor.
  3. Vaginal bleeding, cramping, leaking of amniotic fluid.
  4. Infection.
  5. Injury to the baby.
  6. Baby receiving excess blood.
  7. Fetal bleeding.
  8. Fetal death.
Please return to the hospital immediately if you have regular contractions that last longer than two to three hours, if you have vaginal bleeding or notice that your amniotic fluid is leaking, if you have a fever of higher than 38 degrees Celsius, and if your baby is not moving as much as it normally does.
The procedure can reduce the risk of fetal death due to hemolytic anemia from 50% down to 5-9% of all fetal deaths.
What if the procedure is not performed?
Severe anemia in a fetus can lead to fetal death if untreated.
Please discuss appropriate options with your doctor.

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