Intrauterine Fetal Blood Transfusion for Rh Disease
An intrauterine transfusion provides blood
Rh-positive fetus when fetal red blood cells are being
destroyed by Rh
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
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
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
- 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.
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
antibiotics to prevent infection. She may also be
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
A sensitized mother's
immune system can destroy a large amount of fetal red
blood cells, causing severe
anemia. Intrauterine blood transfusions are done
- Doppler ultrasound of the middle cerebral artery suggests
bilirubin result from
amniocentesis testing shows that the fetus is
moderately to severely affected by Rh sensitization.
shows evidence of fetal
hydrops, such as swollen tissues and
- 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, the method of transfusion,
and the skill of the doctor who does the procedure. Overall, after intrauterine
transfusion through the umbilical cord:2
- More than 90% of fetuses that do not have
- About 75% of fetuses that have hydrops
Intrauterine transfusions may cause:
- Uterine infection.
- Preterm labor.
- Excessive bleeding and mixing
of fetal and maternal blood.
- Amniotic fluid leakage from the
- Fetal death.
What To Think About
Umbilical blood transfusions are
usually done by perinatologists at specialized centers.
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Moise KJ (2009). Hemolytic disease of the fetus and
newborn. In RK Creasy, R Resnik, eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 477–503. Philadelphia:
Branch DW, et al. (2008). Immunologic disorders in
pregnancy. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 313–339. Philadelphia: Lippincott Williams and
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||William Gilbert, MD - Maternal and Fetal Medicine|
|Last Revised||October 20, 2011|