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.
After 24 weeks 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 medicine to prevent labor from beginning, though this is unusual.
What To Expect After Treatment
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
- Doppler ultrasound of the middle cerebral artery suggests anemia.
- 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
Fetal survival after transfusion depends upon the severity of the fetus’s illness and the method of transfusion. Overall, after intrauterine transfusion through the umbilical cord:
- 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.
- Amniotic fluid leakage from the uterus.
- Fetal death.
Twin-twin transfusion syndrome (TTTS) is a condition in which the blood passes unequally between identical twins that share a placenta (monochorionic). Monochorionic twins are a type of identical twins that share a placenta. Within the shared placenta are blood vessels that connect the blood supply of the two fetuses, allowing blood to flow between the twins. In about 15 percent of monochorionic, diamniotic (two amniotic sacs) twins, the blood flow becomes unbalanced, leading to a condition known as Twin-Twin Transfusion Syndrome (TTTS).
In twin-twin transfusion syndrome, the smaller twin (donor) pumps blood to the larger twin (recipient), causing the recipient twin to receive too much blood and the donor to receive too little. The increased volume of blood causes the recipient twin to produce more than the usual amount of urine, which can result in a large bladder, too much amniotic fluid (known as polyhydramnios) and hydrops, a prenatal form of heart failure. The donor twin produces less than the usual amount of urine, resulting in low or no amniotic fluid surrounding it (oligohydramnios) and a small or absent bladder. Without intervention, the condition can be fatal for both twins.
Management of TTTS may include any of the following:
- Expectant management – In situations where surgery is not yet indicated, close monitoring with ultrasound is used to evaluate the condition of both fetuses and look for signs of disease progression.
- Fetoscopic laser surgery – A minimally invasive surgery performed on the placenta to disconnect some of the communicating blood vessels. This procedure stops the transfusion of blood from the donor to the recipient,hopefully halting the progression of TTTS, and is the preferred treatment for TTTS.
- Amnioreduction – Removal of excess amniotic fluid from the larger twin (recipient) which may temporarily help with maternal comfort.
- Selective reduction – A minimally invasive surgery used in severe cases of TTTS to stop the blood flow to the dying twin to maximize the outcome for the surviving twin. This is considered as a last option when the disease process is very advanced and the at-risk twin faces imminent demise. This intervention can protect the co-twin from neurologic impairment and/or demise.
- The results of tests and these treatments will be discussed in detail after evaluation. We are here to help.