Procedure:
Assessment Components:
Intrauterine blood transfusion is a specialized procedure used to treat fetal anaemia. It typically involves the transfusion of compatible, packed red blood cells directly into the fetal circulation, often through the umbilical vein.
Timing:
IUT is generally performed after 18–20 weeks of gestation, as early as fetal anaemia is diagnosed. Multiple transfusions may be needed depending on the severity of anaemia and gestational age.
Preparation:
Preparation includes detailed ultrasound and Doppler assessments, maternal blood testing, crossmatching with donor blood, and often administration of corticosteroids to promote fetal lung maturity. Sedation or anesthesia may be considered depending on fetal activity and maternal comfort.
Technique:
Ultrasound Guidance:
The entire procedure is conducted under continuous high-resolution ultrasound guidance to accurately locate the umbilical cord and guide needle placement.
Needle Insertion and Transfusion:
A fine needle is inserted through the maternal abdomen into the umbilical vein (in the cord or intrahepatic portion). Donor blood, matched for Rh and other antigens, is slowly transfused while monitoring fetal heart rate and well-being.
Uses:
Treatment of Fetal Anemia:
Primarily used to treat severe fetal anaemia, especially due to red cell alloimmunization (e.g., Rh incompatibility), parvovirus B19 infection, or other hemolytic conditions.
Prevention of Hydrops Fetalis:
Helps prevent progression to hydrops fetalis, a life-threatening condition marked by severe fetal swelling and heart failure.
Bridging to Viability:
Provides critical support to the fetus until it is safe for delivery, particularly before fetal lungs are mature enough for life outside the womb.
Advantages:
Life-Saving Intervention:
IUT can significantly improve fetal outcomes in otherwise fatal cases of anaemia.
Targeted Treatment:
Delivers red blood cells directly to the fetus, ensuring the immediate correction of anaemia.
Allows Continuation of Pregnancy:
Enables pregnancies to be prolonged until fetal maturity is achieved, reducing risks associated with extreme prematurity.
Risks and Considerations:
Procedure-Related Complications:
Includes risk of infection, preterm labour, premature rupture of membranes, fetal bradycardia, or even fetal loss (typically <5%).
Maternal Sensitization:
Despite careful crossmatching, there is a risk of maternal immune sensitization, especially in cases of Rh incompatibility.
Technical Complexity:
Requires specialized centres and experienced practitioners due to the high level of precision and care involved.
Aftercare and Follow-Up:
Monitoring Fetal Condition:
Post-procedure ultrasounds and Doppler assessments are used to monitor fetal well-being and assess the need for further transfusions.
Serial Transfusions:
Multiple IUTs may be required every 1–3 weeks until the fetus reaches a gestational age safe for delivery.
Delivery Planning:
Coordination with neonatologists and maternal-fetal medicine specialists is essential for planning the timing and mode of delivery.
Alternatives:
Early Delivery:
In later stages of pregnancy, early delivery may be preferred if the fetus is mature enough and further IUTs carry increased risk.
Intraperitoneal Transfusion:
Less commonly used, this method involves injecting blood into the fetal abdomen, where it is gradually absorbed into circulation.
Plasmapheresis and IVIG in Mother:
In certain cases, maternal treatment may reduce antibody levels, potentially decreasing the severity of fetal anaemia.
Summary:
Intrauterine Blood Transfusion is a critical, highly specialized procedure used to manage severe fetal anaemia and prevent complications such as hydrops fetalis. While it carries some risks, it is often life-saving when performed by experienced teams. Ongoing monitoring, repeat transfusions, and collaborative care are key to optimizing outcomes for both mother and fetus.
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