Fetal Blood Transfusion

(Intrauterine Transfusion; IUT; Intraperitoneal Transfusion; IPT)

Definition

A transfusion is giving healthy blood or blood products from a donor. In this case it is red blood cells that are given to a fetus.

There are 2 types of fetal blood transfusions:

  • Intravascular transfusion (IVT)—needle is passed through the mother’s belly into the fetus’s umbilical cord
  • Intraperitoneal transfusion (IPT)—needle is passed through the mother’s belly and uterus into the fetus’s belly; usually only done if IVT is not possible because of the position of the fetus

Reasons for Procedure

A transfusion is needed when a fetus has severe anemia. Anemia is a low level of red blood cells. These cells are needed to carry oxygen throughout the body. Severe anemia in a fetus can cause death. Anemia can be caused by:

The goals of fetal blood transfusions are to:

  • Prevent or treat fetal hydrops before delivery—Hydrops is caused by severe anemia. It leads to fluid collecting in the skin, lungs, belly, or around the heart. It can develop into heart failure.
  • Continue the pregnancy so the fetus can be born close to due date.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like:

  • Need for cesarean section because of fetal distress after the procedure
  • Premature rupture of membranes and/or premature labor
  • Abdominal bruising or soreness
  • Bleeding, cramping, or leaking fluid from vagina
  • Infection
  • Injury to the fetus
  • Giving too much blood
  • Fetal bleeding
  • A rare condition in which the donor’s blood cells attack the fetus's blood cells

What to Expect

Prior to Procedure

Tests that were already done will be reviewed.

Your belly and womb may need to be viewed. This can be done with ultrasound.

Amniocentesis

Amniocentesis
Copyright © Nucleus Medical Media, Inc.

If the fetus has hydrops, the blood transfusion will be done right away.

Before the transfusion, you may be given:

  • Pain medicine
  • Medicine to help you relax

Anesthesia

Medicine will be used to numb a small area of your belly.

Description of the Procedure

With IVT, medicine may be used to keep the fetus still for a short time. This will decrease the risk of injury to the fetus. During both IVT and IPT, the doctor will keep an eye on the fetus with an ultrasound. The ultrasound will:

  • Show the position of the fetus
  • Guide the movement of the needle through the amniotic sac and into the umbilical cord
  • Record the fetal heart rate

A needle will be inserted into your belly. The needle will be passed through your uterus and into the umbilical cord. (With IPT, it will pass in the fetal belly instead of cord.) The donor blood will be passed to the fetus.

A final blood sample will be taken. It will show the change to the fetus's blood. The doctor will use this to know if the transfusion was enough and when the next one should be.

The transfusions may need to be repeated every 2 to 4 weeks until it is safe to deliver.

How Long Will It Take?

It can take 1 to 2 hours for the entire process.

How Much Will It Hurt?

You will feel pain and cramping where the doctor inserts the needle. The uterus may feel sore. This is more likely if you are close to delivering.

Average Hospital Stay

This procedure is done in a hospital setting. You will be able to go home after the transfusion.

Post-procedure Care

You may be given:

  • Antibiotics to prevent infection
  • Medicine to prevent contractions or labor

Be sure to follow your doctor’s instructions.

After your baby has been delivered, the baby will need to have follow-up blood tests. The doctor will closely monitor the baby for:

  • Anemia
  • Liver damage
  • Heart failure
  • Respiratory failure
  • Other complications if the baby is premature

Call Your Doctor

Call your doctor if any of the following occur:

  • Signs of infection, including fever or chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the needle insertion site
  • You are not feeling your baby moving normally

Know the signs of early labor:

  • Water breaks
  • Uterine contractions
  • Back pain that comes and goes
  • Vaginal bleeding

If you think you have an emergency, call for medical help right away.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org
American Pregnancy Association
http://www.americanpregnancy.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org
Women's Health Matters
http://www.womenshealthmatters.ca

References:

American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 75: Management of isoimmunization in pregnancy. Obstet Gynecol. No. 75. 2006 Aug;108(2):457-464.
Rhesus disease. National Health Services website. Available at: https://www.nhs.uk/conditions/rhesus-disease/treatment/. Updated November 6, 2018. Accessed February 12, 2019.
Rh factor. American Pregnancy Association website. Available at:
...(Click grey area to select URL)
Updated March 2, 2017. Accessed February 12, 2019.
van Kamp I, Klumper F, et al. Complications of intrauterine intravascular transfusion of fetal anemia due to maternal red-cell alloimmunization. Am J Obstet Gynecol. 2005;192:171-177.
Last reviewed February 2019 by Daniel A. Ostrovsky, MD
Last Updated: 2/12/2019

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