Intrauterine Fetal Blood Transfusion for Rh Disease

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

A blood transfusion is given to replace fetal red blood cells that are being destroyed by the Reference Rh-sensitized Opens New Window 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.^{Reference 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 Reference ultrasound Opens New Window image is obtained to determine the position of the fetus and Reference placenta Opens New Window.
• After the mother's abdomen is cleaned with an antiseptic solution, she is given a Reference local anesthetic Opens New Window 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 Reference blood type Opens New Window (usually type O, Rh-negative) is delivered into the fetus's umbilical cord blood vessel.
• The mother is usually given Reference antibiotics Opens New Window to prevent infection. She may also be given Reference tocolytic medicine Opens New Window to prevent labor from beginning, though this is unusual.

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.

A sensitized mother's Reference immune system Opens New Window can destroy a large amount of fetal red blood cells, causing severe Reference anemia Opens New Window. Intrauterine blood transfusions are done when:

• Reference Doppler ultrasound Opens New Window of the middle cerebral artery suggests anemia.
• The Reference bilirubin Opens New Window result from Reference amniocentesis Opens New Window testing shows that the fetus is moderately to severely affected by Rh sensitization.
• Ultrasound shows evidence of fetal Reference hydrops Opens New Window, 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.

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 through the umbilical cord:^{Reference 2}

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

Intrauterine transfusions may cause:

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

Umbilical blood transfusions are usually done by perinatologists at specialized centers.

Complete the special treatment information form (PDF) (What is a Reference PDF Opens New Window document?) to help you understand this treatment.

Citations

1. Moise KJ (2009). Hemolytic disease of the fetus and newborn. In RK Creasy, R Resnik, eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 477–503. Philadelphia: Saunders Elsevier.

2. Branch DW, et al. (2008). Immunologic disorders in pregnancy. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 313–339. Philadelphia: Lippincott Williams and Wilkins.

© 1995-2011, Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Reference Terms of Use. Reference How this information was developed to help you make better health decisions.