Fetal Hydrops And Stillbirth (hgb less than 4 gm/dl).
Hepatosplenomegaly.
Neonatal Jaundice (post delivery).
Complications Of Neonatal Kernicterus (Lethargy, Hypertonicity, Hearing Loss, Cerebral Palsy And Learning Disability).
Neonatal Anemia (Hgb < 11 gm/dl).
Hydrops Fetalis
Definition and Characteristics
Is a form of in utero heart failure.
In the setting of Rh alloimmunization, it is characterized by the presence of:
Fetal ascites.
Pericardial effusion.
Pleural effusion.
Subcutaneous edema (best seen as scalp edema).
Polyhydramnios.
Hydrops Fetalis Ultrasound
Intrauterine Transfusion
Goal and Procedure
Initially introduced in 1963.
Started as an intraperitoneal transfusion.
Currently is usually an intravascular transfusion.
The goal is to transfuse fresh group O, Rh-negative PRBCs.
Blood is screened, irradiated, washed, and processed through a leukocyte-poor filter.
Curare is usually injected directly into the fetal thigh before transfusion to immobilize the fetus during the procedure.
Repeat transfusions are generally scheduled at 1- to 3-week intervals.
The final transfusion is typically performed at 34 weeks’ gestation.
Delivery when the lungs are mature.
Intravascular Blood Transfusion
Details and Goals
Goal is to have post-transfusion Hct 40-45%.
Can infuse about 10 ml/min.
Estimate requirement based on EFW and pre-transfusion Hct.
Repeat in 1 week, then about every 3 weeks.
Hct falls about 1%/day.
Goal: keep Hct > 25%.
Smaller volumes, therefore more procedures compared to IPT.
Fetal loss about 1.5% per procedure.
Fetal Intraperitoneal Procedure
Mechanism and Steps
Transfusion RBCs are absorbed through the subdiaphragmatic lymphatics, proceed through the right lymphatic duct into the fetal intravascular compartment.
Blood absorbed within 7-9 days.
Removal of ascitic fluid at the time of transfusion.
Fetal Intraperitoneal Procedure Details
Technique and Volume Calculation
A 20-gauge spinal needle is inserted into the peritoneal cavity.
The RBCs are slowly injected manually in 10-mL aliquots.
If fetal bradycardia occurs during the procedure, the transfusion is terminated.
For intraperitoneal transfusions, the volume to be infused is based on the following formula:
Volume = [gestational age (weeks) – 20] × 10.
