An intrauterine blood transfusion is standard treatment for fetal anemia in pregnancies affected by hemolytic disease of the fetus and newborn (HDFN).
All precautions are taken to ensure the best outcomes for mother and baby, but there are still risks involved. The mother receives local anesthetic, IV sedation and antibiotics to help prevent fetal distress and movement, the fetus may also receive sedation as well as pain relief.
What is an intrauterine transfusion?
An intrauterine transfusion is a blood transfusion performed during pregnancy to treat fetal anemia associated with HDFN. It helps prevent or delay the onset of severe fetal anemia, which can cause life-threatening complications such as hydrops fetalis and heart failure.
Guided by ultrasound, the doctor inserts a long, thin needle into the mother’s abdomen and then into the fetus’s umbilical cord or abdomen. The needle then delivers carefully matched donated red blood cells to replace those destroyed by maternal antibodies.
An IUT may need to be repeated every 2-4 weeks until birth. It effectively increases the amount of oxygen delivered to the organs, improving the baby’s growth and development and reducing the likelihood of an early delivery.
What are the main risks of an IUT?
If left untreated, HDFN can lead to long-term neurological damage and fetal death. Proactive treatment during pregnancy including via IUT has shown to significantly improve fetal outcomes.
However, if the fetus moves around a lot during an intrauterine transfusion potential risks include:
- Difficulty accessing the umbilical cord.
- The needle slipping and causing injury.
- Making the procedure longer than planned, causing fetal distress.
- Postponing the procedure to another time.
There are other associated risks to keep in mind, particularly in fetuses of less than 20 weeks’ gestation. While severe adverse events are uncommon, they may include:
- Fetal distress
- Bleeding from the umbilical cord
- Vaginal bleeding
- Inflammation of the placenta
- Contractions, membrane rupture
- Fetal or uterine infection
- Preterm delivery
- Fetal death
Ways to reduce the risks of intrauterine transfusion
In preparation for the IUT, the mother receives IV sedation, local anesthetic at the needle entry site and antibiotics. This sedation usually calms the fetus, but it necessary, the fetus can also receive a small dose of sedation to reduce movements or immobilize the fetus. This is only short-term and wears off after a few hours.
Both mother and baby are closely monitored throughout the procedure. The baby’s heart rate, blood flow and position are tracked via ultrasound.
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