36460 Transfusion, intrauterine, fetal

Name of the Procedure:

Transfusion, intrauterine, fetal
Common names: Intrauterine blood transfusion (IUT)

Summary

An intrauterine transfusion (IUT) is a medical procedure in which blood is directly transfused to a fetus while still inside the womb. This is typically done to treat severe fetal anemia or other blood-related disorders.

Purpose

Medical Condition:

• Severe fetal anemia
• Rh disease or erythroblastosis fetalis
• Parvovirus B19 infection in pregnant women

Goals/Outcomes:

• To restore the fetus’s normal red blood cell levels
• Prevent fetal heart failure and hydrops fetalis
• Improve fetal health outcomes and increase the chances of a full-term pregnancy

Indications

• Fetal anemia detected via ultrasound or blood tests
• Positive maternal-fetal Rh incompatibility
• Evidence of fetal hydrops
• Parvovirus B19 infection in the fetus
• Mom has a history of severe anemia in previous pregnancies

Preparation

• Fasting may not be necessary but check with the healthcare provider
• Blood tests to determine blood type and matching
• Ultrasound to assess the fetus's condition and precise location
• Possible administration of steroids to accelerate fetal lung maturity

Procedure Description

1. Preparation:
   • The mother is positioned and an ultrasound is used to visualize the fetus.
2. Local Anesthesia:
   • Local anesthesia is administered to the mother at the insertion site.
3. Insertion:
   • A thin, long needle is carefully inserted through the mother's abdomen and uterus into the umbilical vein or directly into the fetus's abdomen.
4. Transfusion:
   • Compatible donor blood is transfused through the needle into the fetus.
5. Monitoring:
   • Continuous ultrasound monitoring ensures proper placement and successful transfusion.
6. Completion:
   • The needle is withdrawn, and the mother and fetus are monitored for any immediate complications.

Tools/Equipment:

• Ultrasound machine
• Sterile needle
• Blood transfusion set
• Donor blood

Anesthesia/Sedation:

• Local anesthesia is typically used to numb the insertion site.

Duration

The procedure typically takes about 60 to 90 minutes.

Setting

Performed in a hospital, usually in a specialized labor and delivery unit or a fetal medicine center.

Personnel

• Perinatologist or maternal-fetal medicine specialist
• Nurses specialized in fetal-maternal medicine
• Anesthesiologist (if general anesthesia is needed)
• Sonographer

Risks and Complications

Common Risks:

• Bleeding at the insertion site
• Infection

Rare Risks:

• Preterm labor
• Premature rupture of membranes
• Injury to the fetus
• Fetal distress

Complications Management:

• Immediate intervention by the medical team
• Close fetal monitoring and possibly emergency delivery if complications arise

Benefits

• Increases the chance of carrying the pregnancy to full term
• Improves fetal anemia and overall fetal health
• Reduces the risk of fetal heart failure and hydrops fetalis

Recovery

• Post-procedure monitoring of both mother and fetus
• Ultrasound evaluation of fetal well-being
• Follow-up appointments to assess fetal growth and health
• Most patients can return to normal activities within a day or two, with some restrictions as advised by their healthcare provider

Alternatives

• Early delivery if the fetus is viable and can be treated ex utero
• No intervention if risks outweigh the benefits (close monitoring)
• Plasmapheresis or exchange transfusion in the newborn period

Pros and Cons:

• Early delivery: Immediate neonatal care but risks of prematurity
• No intervention: Avoids procedural risks but potential for worsening fetal anemia
• Plasmapheresis: Can manage maternal-fetal incompatibility but may not resolve existing fetal anemia

Patient Experience

• The patient may feel slight discomfort during needle insertion.
• Anxiety due to the nature of the procedure; emotional support is essential.
• Post-procedure, slight cramping or soreness at the insertion site.
• Pain management: Local anesthesia used during the procedure, mild analgesics may be recommended post-procedure if needed.