Intrauterine fetal blood transfusion for Rh disease

Treatment Overview

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An intrauterine transfusion provides blood to an Rh-positive fetus when fetal red blood cells are being destroyed by Rh antibodies.

A blood transfusion is given to replace fetal red blood cells that are being destroyed by the Rh-sensitized mother's immune system. This treatment is meant to keep the fetus healthy until he or she is mature enough to be delivered.

Transfusions can be given through the fetal abdomen or, more commonly, by delivering the blood into the umbilical vein. Umbilical cord vessel transfusion is the preferred method because it permits better absorption of blood and has a higher survival rate than does transfusion through the abdomen.¹

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

• The mother is sedated, and an ultrasound image is obtained to determine the position of the fetus and placenta.
• After the mother's abdomen is cleaned with an antiseptic solution, she is given a local anesthetic injection to numb the abdominal area where the transfusion needle will be inserted.
• Medicine may be given to the fetus to temporarily stop fetal movement.
• Ultrasound is used to guide the needle through the mother's abdomen into the fetus's abdomen or an umbilical cord vein.
• A compatible blood type (usually type O, Rh-negative) is delivered into the fetus's umbilical cord blood vessel.
• The mother is usually given antibiotics to prevent infection. She may also be given tocolytic medication to prevent labor from beginning, though this is unusual.

What To Expect After Treatment

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A short recovery period (approximately 1 to 3 hours) is necessary 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

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A sensitized mother's immune system can destroy a large amount of fetal red blood cells, causing severe anemia. Intrauterine blood 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 immediately.

In a severely affected fetus, transfusions are done every 1 to 4 weeks until the fetus is mature enough to be delivered safely. Amniocentesis may be done to determine the maturity of the fetus's lungs before delivery is scheduled.

How Well It Works

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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:²

• More than 90% of fetuses that do not have hydrops survive.
• About 75% of fetuses that have hydrops survive.

Risks

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Intrauterine transfusions may cause:

• Uterine infection.
• Fetal infection.
• Preterm labor.
• Excessive bleeding and mixing of fetal and maternal blood.
• Amniotic fluid leakage from the uterus.
• Fetal death.

What To Think About

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Umbilical blood transfusions can be done as early as 17 weeks into the pregnancy, although it is preferable to wait until 20 weeks.³ These transfusions are usually done by perinatologists at specialized centers.

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References

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Citations

1. American College of Obstetricians and Gynecologists (1996). Management of isoimmunization in pregnancy. ACOG Educational Bulletin No. 227, pp. 1–7. Washington, DC: American College of Obstetricians and Gynecologists.

2. Porter TF, et al. (2003). Immunologic disorders in pregnancy. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 313–338. Philadelphia: Lippincott Williams and Wilkins.

3. Ryan G, Morrow RJ (1994). Fetal blood transfusion. Clinics in Perinatology, 21(3): 573–589.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer	Gregory A L Davies, MD, FRCSC, FACOG - Maternal-Fetal Medicine
Last Updated	November 2, 2007