This procedure is done when a fetus suffers from severe
anemia. Anemia is
a lack of red blood cells. A transfusion means giving the fetus red blood cells from a donor.
There are 2 types of fetal blood transfusions: Intravascular transfusion (IVT)—done through the mother’s abdomen into the fetus’s umbilical cordIntraperitoneal transfusion (IPT)—done through the mother’s abdomen and uterus into the fetus’s abdomen; usually only done if IVT is impossible to do because of the position of the fetus and the umbilical cord
A transfusion is needed when the fetus's blood count falls too low. Severe anemia in a fetus can cause death. Anemia can be caused by: Rh incompatibility—the mother and fetus have a different type of blood, and mother’s antibodies to fetal blood cells destroy fetal blood cells
Parvovirus B19 infection—a viral infection in the mother
Twin-to-twin transfusion syndrome—can occur in twin pregnancies where development is in 1 chorionic sac
The goals of fetal blood transfusions are
to: Prevent or treat fetal hydrops before delivery—Hydrops is caused by severe anemia in the fetus, which develops into heart failure. This leads to fluid collecting in the skin, lungs, abdomen, or around the heart.Continue the pregnancy so the fetus can be born close to term
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems like:
because of fetal distress after the procedure
Premature rupture of membranes
and/or premature labor
Abdominal bruising or sorenessBleeding, cramping, or leaking fluid from vaginaInfectionInjury to the fetusGiving too much bloodFetal bleedingA rare condition in which the donor’s blood cells attack the fetus's blood cells
Tests may be done to see if the fetus has severe anemia or fetal hydrops.
Body fluids may be examined. This can be done with: AmniocentesisCordocentesis
Your abdomen may need to be viewed. This can be done with
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If the fetus has hydrops, the blood transfusion will be done right away.
Before the transfusion, you may be given: Pain medicationMedication to help you relax
Local anesthesia numbs a small area of your abdomen.
With IVT, the fetus might be paralyzed for a short time. This is to allow access to fetal blood vessels and to reduce injury to the fetus. During both IVT and IPT, the doctor will monitor the fetus with an ultrasound scan. The ultrasound will: Show the position of the fetusGuide the placement of the needle through the amniotic sac and into the vessel in the umbilical cordRecord the fetal heart rate
A needle will be inserted into your abdomen. Using ultrasound, the doctor will make sure the needle is placed correctly. The needle will go through your abdomen and be inserted into the umbilical cord (IUT) or into the fetal abdomen (IPT). Blood will be transfused to the fetus.
Before the needle is removed, a final blood sample will be taken. This is to determine the fetus's blood level. It will show whether the transfusion was enough and when the next one should be.
The transfusions may need to be repeated every 2-4 weeks until your doctor decides that it is safe to deliver the fetus.
A 10 ml IVT transfusion will take 1-2 minutes. Usually, between 30-200 ml is transfused during a single procedure.
You will feel pain and cramping where the doctor inserts the needle. If you are close to delivering the fetus or if the procedure is long, the uterus can be sore.
This procedure is done in a hospital setting. You will be able to go home after the transfusion. If complications occur, you may need to have a cesarean section.
You may be given: Antibiotics to prevent infectionMedication 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: AnemiaLiver damageHeart failureRespiratory failure
Other complications if the baby is
Call your doctor if any of the following occur: Signs of infection, including fever or chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the needle insertion siteYou are not feeling your baby moving normally
Know the signs of early labor: Water breaksUterine contractionsBack pain that comes and goesVaginal bleeding
If you think you have an emergency, call for medical help right away.
Gibson BE, Todd A, et al. British Committee for Standards in Haematology Transfusion Task Force: Writing group. Transfusion guidelines for neonates and older children.
Br J Haematol. 2004; 124: 433-453.
American College of Obstetricians and Gynecologists. ACOG practice bulletin No. 75: Management of isoimmunization in pregnancy.
No. 75. 2006 Aug;108(2):457-464.
Rh factor. American Pregnancy Association website. Available at:
http://www.americanpregnancy.org/pregnancycomplications/rhfactor.html. Updated August 2015. Accessed December 28, 2016.
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 December 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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