Intrauterine blood transfusions (IUTs) are often required to treat hemolytic disease of the fetus and newborn (HDFN), and the intrahepatic intraperitoneal approaches appear to be superior to other techniques, according to a recently published study in Ultrasound in Obstetrics and Gynecology.
An IUT involves transfusing red blood cells directly into fetal circulation during pregnancy. Physicians can use several possible entry points to perform the transfusion, including the umbilical vein, the intrahepatic vein, and the intestinal serous lining (peritoneum).
In order to determine which access site or combination of access sites offered the most clinical benefits, the authors analyzed clinical data from the Leiden University Medical Center (LUMC) in Leiden, Netherlands.
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Results of the study
The authors analyzed over 800 IUTs in over 300 fetuses between 2006 and 2022. Approximately 46% of transfusions used the placental cord insertion, 34% were intrahepatic + intraperitoneal, and 10% were intrahepatic only. The rate of fetal demise was 13%, and there was a case of procedure-associated fetal demise in each transfusion-type group.
Results showed that transfusions administered through the intrahepatic+intraperitoneal route led to a slower decline in hemoglobin levels over the following months. These results were consistent independent of the number of transfusions.
Further analysis determined that the median interval between transfusions was similar for the placental cord insertion and intrahepatic approach (3 weeks), in patients who received IUTs through the combined approach the median interval was 3 weeks and 5 days.
The study’s implications
The results suggest that the former could reduce the required frequency of transfusions (and procedure-related adverse effects) and improve fetal hemodynamic stability between transfusions.
“We observed a [five]-day interval difference between intrahepatic with vs without intraperitoneal transfusion,” the authors wrote. “Although this difference may appear minor, it could offer benefits in specific cases, such as managing early-onset severe HDFN or extending the interval until term gestation after the final IUT,”
However, the authors remarked that despite its benefits regarding hemoglobin levels, the combined approach requires more time and is associated with complications such as abdominal wall hematoma.
Therefore, the choice of transfusion technique should be assessed individually based on the patient’s characteristics as well as on the specialist’s training and experience.
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