Intrauterine blood transfusion benefits conditions and risks

Intrauterine blood transfusion is a lifeline for pregnant mothers facing complications during pregnancy. This medical procedure serves as a crucial intervention for fetuses at risk of severe anemia while still in the womb.Understanding the details of intrauterine blood transfusion, its benefits, and potential risks is essential for any expectant mother navigating a high-risk pregnancy.At Dalili Medical, we will provide a comprehensive guide on how intrauterine bloo transfusion is performed, why it is a life-saving procedure, and how it impacts the health of both the baby and the mother.

Intrauterine Blood Transfusion (IUT)

What is Intrauterine Blood Transfusion?
Intrauterine blood transfusion (IUT), also known as fetal blood transfusion, is a precise medical procedure performed during pregnancy to treat severe fetal anemia. This condition often occurs due to Rhesus disease, a blood disorder where the mother’s immune system attacks the fetus’s red blood cells, leading to life-threatening complications. During this procedure, donor blood compatible with the fetus is transfused directly through the umbilical vein, helping to restore red blood cells and ensure adequate oxygen supply to the baby.

Why is Intrauterine Blood Transfusion Performed?
Blood type is classified as A-B-O and also includes a factor called Rhesus (Rh). If the mother is Rh-negative and the fetus is Rh-positive, the mother’s body may produce antibodies that attack the fetal red blood cells, causing anemia. To manage this condition, a blood transfusion is given to the fetus through the umbilical cord. The donor blood used must be Rh-negative to prevent further immune reactions and help improve the fetus’s condition.

What Happens After the Transfusion?
While IUT is a life-saving procedure, it carries some risks, such as preterm labor or pregnancy loss. However, if left untreated, severe fetal anemia can lead to stillbirth. Possible complications during the procedure include:

Umbilical cord blood flow disruption
Fetal bradycardia (slow heart rate)
Umbilical cord bleeding

In cases of severe bradycardia, an emergency cesarean section may be required. Other potential complications include amniotic fluid leakage or infection. However, the success rate of pregnancy following IUT is approximately 90%, though this decreases in cases of severe complications like hydrops fetalis or significant growth restriction. In rare instances, IUT may result in cerebral palsy or hearing loss.

Why Does Blood Incompatibility Occur?
Blood type incompatibility occurs due to the presence of specific antigens, such as ABO and Rh factors. When there is an incompatibility between maternal and fetal blood, an intrauterine transfusion may be necessary. While Rh disease is the most common cause, rare blood group incompatibilities, such as Kell group incompatibility, can also lead to fetal anemia.

Additionally, some infectious diseases, like Parvovirus B19, can cause fetal anemia by preventing red blood cell production. In these cases, intrauterine blood transfusion may be the only solution to save the fetus’s life.

When is Intrauterine Blood Transfusion Performed?
IUT is typically performed after the 18th week of pregnancy. Guided by ultrasound, a thin needle is inserted into the umbilical vein, and specially prepared O-negative donor blood is transfused. This procedure helps increase fetal blood volume and is repeated every 2 to 3 weeks, depending on the severity of the condition.

Steps of Intrauterine Blood Transfusion (IUT)

Intrauterine blood transfusion is a highly delicate procedure that requires significant expertise and must be performed by a specialized fetal medicine doctor. It is a crucial medical intervention used to improve fetal health and prevent serious complications, but it is not always necessary. The final decision is made after a thorough evaluation by a specialist, weighing the risks and benefits for each case.

Steps of the Procedure

IUT involves delivering compatible blood to the fetus through the umbilical cord or the fetal abdomen. This precise procedure must be carried out in a specialized hospital. The detailed steps are as follows:

1. Diagnosing the Condition and Confirming the Need for Transfusion

Before proceeding with IUT, the doctor must confirm that the fetus is suffering from severe anemia. This is determined through:

✔ Doppler ultrasound: Measures blood flow in the middle cerebral artery (MCA) to assess the severity of anemia.
✔ Maternal blood test: Detects any antibodies that might attack fetal red blood cells.
✔ Cordocentesis (fetal blood sampling): In some cases, the doctor takes a direct blood sample from the umbilical cord to check hemoglobin levels and determine the need for transfusion.

2. Preparing the Donor Blood

✔ The blood is carefully selected to be fully compatible with the fetus, usually O-negative and free from antibodies.
✔ White blood cells are removed to minimize immune reactions.
✔ The blood is screened to ensure it is free from infections or diseases.

3. Preparing the Mother for the Procedure

✔ The mother lies on her back, and her abdomen is thoroughly disinfected.
✔ A local anesthetic may be given to numb the skin and reduce discomfort.
✔ A mild sedative might be administered to help the mother stay calm.
✔ The fetus’s heart rate is continuously monitored via ultrasound.

4. Inserting the Needle into the Umbilical Cord

✔ Using ultrasound guidance, the doctor locates the best entry point in the umbilical cord or fetal abdomen.
✔ A very fine needle is inserted through the mother’s abdomen and carefully guided to the umbilical vein or a fetal blood vessel.
✔ Once positioned correctly, the transfusion begins at a slow rate to allow the fetus to adjust.

5. Monitoring the Fetus During the Transfusion

✔ The blood is transfused gradually over 30-60 minutes, while the doctor closely monitors the fetal heart rate.
✔ If any irregularities in the fetal heartbeat or an adverse reaction occur, the procedure may be stopped immediately.

6. Completing the Procedure and Post-Transfusion Monitoring

✔ After the transfusion, the needle is carefully removed, and the fetal heartbeat is reassessed via ultrasound.
✔ The mother remains under observation for at least one hour to ensure there are no complications such as bleeding or contractions.
✔ In some cases, the mother may receive a steroid injection to help fetal lung development if preterm delivery is a concern.

7. Post-Transfusion Follow-Up

✔ A follow-up ultrasound is scheduled within a few days to assess the fetus’s condition.
✔ Some fetuses may require multiple transfusions until birth.
✔ The doctor will determine whether the pregnancy can continue safely or if early delivery is necessary, depending on the fetus’s progress.

Is the Procedure Painful for the Mother or the Fetus?

The procedure is not significantly painful for the mother because a very fine needle is used, and local anesthesia helps reduce discomfort.

For the fetus, there is no sensation of pain, but slight movement during the transfusion is possible, which is normal and not a cause for concern.

When Might the Fetus Need Multiple Transfusions?

Severe anemia: If the fetus has a critical shortage of red blood cells, transfusions may be required every two weeks.
Genetic blood disorders: Conditions like thalassemia may necessitate regular transfusions until birth.
Rapid breakdown of transfused blood: In some cases, the immune system may recognize the new blood as foreign and destroy it quickly, requiring additional transfusions.
Post-transfusion bleeding: If the fetus experiences internal bleeding after the first transfusion, another session may be needed to replace lost blood.

Conditions Requiring Intrauterine Blood Transfusion (IUT)

1. Rh Incompatibility

If the mother has a negative Rh factor (-Rh) and the father has a positive Rh factor (+Rh), the mother’s immune system may attack the fetus’s red blood cells.
If complications occurred in a previous pregnancy due to Rh incompatibility, the fetus may require an intrauterine blood transfusion.

2. ABO Incompatibility

Incompatibility between the mother’s and father’s blood types usually does not cause severe fetal anemia, so an intrauterine transfusion is generally not needed.

3. Rare Blood Type Incompatibility

In rare cases, blood incompatibility can occur due to uncommon antigens, such as the Kell blood group, which may necessitate an intrauterine transfusion.

4. Severe Fetal Anemia

This occurs when the mother’s immune system attacks the fetus’s red blood cells, leading to rapid blood loss.
If left untreated, it can result in fetal heart failure.

5. Intrauterine Infection Leading to Red Blood Cell Destruction

Some viruses, such as Parvovirus B19, can cause a severe reduction in fetal red blood cells, leading to life-threatening anemia that requires a transfusion.

6. Genetic Disorders or Blood Diseases

Inherited conditions such as severe thalassemia or sickle cell anemia can cause rapid red blood cell destruction, requiring repeated intrauterine transfusions.

7. Fetal Hemorrhage (Internal Bleeding in the Womb)

If the fetus suffers internal bleeding due to partial placental abruption or umbilical cord trauma, it may lose a significant amount of blood and require a transfusion to survive.

Types of Blood Transfusions

There are different types of blood transfusions, depending on the patient’s specific needs.

1. Whole Blood Transfusion

✔ What is it?

The entire blood, including red blood cells, plasma, and platelets, is transferred from the donor to the recipient.

✔ When is it used?

Severe hemorrhage, such as major accidents or extensive surgeries.
Massive internal bleeding leading to significant blood loss.

It is rarely used because, in most cases, only specific blood components are needed rather than whole blood.

2. Red Blood Cell Transfusion

✔ What is it?

Red blood cells are separated from plasma and transfused to compensate for low levels.

✔ When is it used?

Severe anemia due to iron deficiency or vitamin B12 deficiency.
Acute blood loss from major bleeding.
Inherited blood disorders like thalassemia or sickle cell anemia.

3. Plasma Transfusion

✔ What is plasma?

Plasma is the liquid portion of blood, containing clotting proteins and antibodies that help stop bleeding and fight infections.

✔ When is it used?

Clotting disorders, such as hemophilia or excessive blood thinning.
Severe burns, to replace lost proteins and fluids.
Liver diseases, which cause a deficiency in clotting factors.

4. Platelet Transfusion

✔ What are platelets?

Platelets are blood cells responsible for clot formation and stopping bleeding.

✔ When is it used?

Low platelet count due to chemotherapy or leukemia.
Severe clotting disorders that cause excessive bleeding.
Major surgeries where there is a high risk of bleeding.

5. Intrauterine Blood Transfusion (IUT)

✔ What is it?

A blood transfusion given to the fetus while still in the womb, usually via the umbilical cord.

✔ When is it used?

Severe fetal anemia due to blood type incompatibility.
Intrauterine infections that destroy red blood cells.
Genetic blood disorders, such as thalassemia or sickle cell anemia.

6. Autologous Blood Transfusion

✔ What is it?

The patient donates their own blood before a surgery where blood loss is expected.

✔ When is it used?

Major surgeries, such as heart or orthopedic procedures.
Reduces the risk of immune reactions or infection transmission since the blood comes from the same person.

7. Exchange Transfusion

✔ What is it?

The patient’s blood is gradually removed and replaced with donor blood.

✔ When is it used?

Newborns with severe jaundice due to blood incompatibility with the mother.
Severe sickle cell anemia, when rapid red blood cell destruction occurs.
Poisoning or autoimmune diseases that require complete blood purification.

Benefits of Intrauterine Blood Transfusion (IUT)

Intrauterine blood transfusion is a crucial procedure that helps save the lives of fetuses in critical conditions. It significantly improves their health and prevents severe complications. The key benefits include:

1. Treating Severe Fetal Anemia

✔ What happens?

If the fetus suffers from a severe deficiency in red blood cells, it may be at risk of heart failure or even intrauterine death.
Blood transfusion increases hemoglobin levels and improves fetal health.

2. Reducing the Risk of Hydrops Fetalis

✔ What’s the problem?

Severe anemia can cause excessive fluid accumulation around fetal organs, leading to extreme swelling known as Hydrops Fetalis, a life-threatening condition.

✔ How does blood transfusion help?

Replenishes red blood cells.
Prevents fluid buildup and improves the fetus’s condition.

3. Reducing the Need for Preterm Birth

✔ Why is this important?

In cases of severe anemia, doctors might have to deliver the baby prematurely to save its life.
Blood transfusion allows the fetus to remain in the womb for a longer period, promoting normal growth and reducing the risks associated with premature birth.

4. Saving the Fetus in Cases of Intrauterine Hemorrhage

✔ What causes fetal bleeding?

Umbilical cord bleeding or partial placental abruption can lead to severe blood loss in the fetus.
Blood transfusion helps replace lost blood and prevent fetal death.

5. Reducing Postnatal Complications

IUT helps prevent several complications after birth, including:

Severe jaundice caused by blood incompatibility between the mother and fetus.
The need for postnatal blood transfusion, as the issue is addressed before birth.
Oxygen deficiency due to anemia, improving long-term fetal health.

6. Improving Fetal Survival and Overall Health

✔ How does it help?

Enhances vital organ function.
Allows the fetus to grow normally until birth without severe complications.

7. Reducing Risks Associated with Postnatal Blood Transfusion

✔ Why is IUT advantageous?

It directly treats the fetus, reducing the need for transfusions after birth.
Lowers the risk of immune reactions and infections that might occur with postnatal transfusions.

Conditions for Intrauterine Blood Transfusion

IUT is a highly delicate procedure performed to save fetuses suffering from severe anemia. To ensure safety and effectiveness, specific conditions must be met:

1. Accurate Diagnosis of Fetal Condition

Before performing IUT, doctors must confirm that the fetus has severe anemia or a critical shortage of red blood cells. Diagnosis includes:

Middle Cerebral Artery (MCA) Doppler ultrasound: If blood flow is faster than normal, it indicates fetal anemia.
Cordocentesis (fetal blood sampling from the umbilical cord): Directly measures hemoglobin levels.
Maternal blood tests: Detects maternal antibodies attacking fetal red blood cells (as in blood type incompatibility).

2. Appropriate Gestational Age

Not all fetuses can tolerate IUT. It is only performed within a specific gestational window:

Between 18 and 35 weeks of pregnancy.
Before 18 weeks: The fetal blood vessels are too small, making umbilical cord access difficult.
After 35 weeks: In some cases, early delivery is preferred over IUT, as the fetus can survive outside the womb.

3. Compatible Blood Type for Transfusion

The transfused blood must be perfectly matched to prevent immune reactions. The ideal choice is:

O-negative blood, as it is the safest and least likely to trigger an immune response.
Antibody-free blood, to prevent fetal red blood cell destruction.
Leukocyte-depleted blood, to minimize immune reactions.

4. Performing the Procedure in a Specialized Center

Intrauterine blood transfusion is a highly complex procedure that requires exceptional skill. Therefore, it must be performed in a well-equipped hospital with:

A specialized medical team experienced in fetal medicine and high-risk obstetrics.
Advanced ultrasound equipment to precisely guide the needle to the umbilical cord.
Emergency protocols in place, as complications like bleeding or preterm labor may occur during the procedure.

5. Careful Monitoring After Blood Transfusion

Following the procedure, close fetal monitoring is essential to ensure stability, particularly by:

Measuring blood flow in the brain to confirm improvement in anemia.
Monitoring heart rate to detect any potential complications.
In some cases, the fetus may require multiple transfusion sessions, depending on how quickly the transfused blood is broken down. The number of sessions is determined based on the progression of the condition.

6. Preparing for Potential Preterm Delivery

If the fetus remains unstable after blood transfusion, the doctor may decide to deliver the baby early to ensure survival. Therefore:

A neonatal intensive care unit (NICU) team must be ready to provide immediate care.
Incubators and ventilators should be available if the baby is born prematurely and requires respiratory support.

Precautions to Prevent Blood Incompatibility During Pregnancy

Blood type incompatibility, particularly Rh incompatibility, can lead to serious complications such as fetal anemia or hydrops fetalis. Preventive measures are essential to reduce these risks.

1. Blood Type and Antibody Screening

Early in pregnancy, the mother must undergo blood type testing to determine whether she is Rh-negative or Rh-positive.
If the mother is Rh-negative, additional testing is required:
- Indirect Coombs Test: Detects maternal antibodies that might attack fetal red blood cells.
- Negative result: No antibodies present, which is a good sign.
- Positive result: Indicates that the mother’s immune system has already started attacking fetal red blood cells, requiring close monitoring.

2. Anti-D Injection (RhoGAM) to Prevent Antibody Formation

If the mother is Rh-negative, she needs an Anti-D injection to prevent her immune system from producing antibodies against fetal red blood cells.

✔ When is the Anti-D injection given?

At 28–30 weeks of pregnancy as a preventive measure.
Within 72 hours after delivery, if the newborn is Rh-positive.
Immediately after any bleeding, miscarriage, ectopic pregnancy, or amniocentesis, to prevent sensitization.

Note: If the baby is Rh-negative, like the mother, there is no need for the postnatal Anti-D injection.

3. Regular Monitoring Through Ultrasound and Blood Tests

Doctors may recommend:

Middle Cerebral Artery (MCA) Doppler ultrasound to monitor fetal blood flow.
If fetal anemia is suspected, further tests may include:
- Amniotic fluid analysis to measure bilirubin levels.
- Cordocentesis (fetal blood sampling) to check hemoglobin levels.

4. Extra Precautions in Cases of Bleeding or Miscarriage

In cases of bleeding, miscarriage, ectopic pregnancy, or amniotic fluid sampling, the Anti-D injection must be administered immediately to prevent future antibody formation.

5. Postnatal Monitoring

After delivery, the baby’s blood type should be tested. If the baby is Rh-positive:

The mother must receive an Anti-D injection within 72 hours.
The baby should be monitored for severe jaundice due to blood incompatibility, which may require phototherapy or exchange transfusion.

Potential Complications of Intrauterine Blood Transfusion (IUT)

Although IUT is a life-saving procedure, it carries some risks and potential complications.

1. Preterm Birth

One of the most common complications, as any intrauterine intervention may trigger uterine contractions, leading to premature delivery.
✔ How is this managed?
The medical team is always prepared for possible preterm birth, ensuring that NICU support is available if needed.
Sometimes, medications to relax the uterus are given after the procedure to reduce the risk of early labor.

2. Bleeding from the Umbilical Cord or Placenta

The needle used for the procedure enters a blood vessel in the umbilical cord or placenta, which may cause minor bleeding.
✔ In severe cases:
If heavy bleeding occurs, the doctor may stop the procedure immediately.
In some cases, the fetus may require an additional blood transfusion to compensate for the blood loss.

3. Amniotic Fluid Leakage

Inserting the needle through the amniotic sac may cause a small fluid leak.
✔ If leakage persists:
There is an increased risk of preterm labor, which requires close monitoring.

How to Manage These Complications?

✔ Complete bed rest for the mother after the procedure.
✔ Monitoring amniotic fluid levels via ultrasound to ensure they are not decreasing significantly.

4. Irregular Fetal Heartbeat ❤️

After the blood transfusion, the fetus may experience a temporary increase or decrease in heart rate as the body adjusts to the new blood volume.

✔ How to manage this issue?

Ultrasound monitoring to ensure the heart rate returns to normal.
In severe cases, medications may be given to regulate the fetal heartbeat.

5. Fetal Rejection of Transfused Blood (Very Rare)

A rare immune reaction can occur if the transfused blood is not perfectly matched, leading to rapid destruction of red blood cells.

✔ How to prevent this issue?

Ensuring complete blood compatibility and using donor blood that is free from antibodies.
Monitoring the fetus after the procedure to detect any signs of an immune reaction.

6. Need for Additional Blood Transfusion Sessions

In cases of severe fetal anemia, the transfused red blood cells may break down over time, requiring multiple transfusions.

✔ How to manage this issue?

Continuous ultrasound monitoring and hemoglobin level testing in the fetus.
Determining the number of transfusions needed based on the fetus’s response.

7. Pregnancy Loss (Very Rare)

Although the procedure is generally safe, severe complications may lead to fetal loss, especially if the fetus is already extremely weak before the transfusion.

✔ How to minimize this risk?

Performing the procedure in a highly specialized hospital under an expert medical team.
Assessing the fetus’s condition before the procedure to ensure it can tolerate the intervention.

How to Reduce Risks and Improve Post-Transfusion Care?

Intrauterine blood transfusion is a highly delicate procedure, but with proper medical care and careful monitoring, risks can be minimized, ensuring the safety of both the mother and fetus.

Reducing Risks During and After the Procedure

✔ Choosing a Specialized Medical Center

The procedure must be performed in a well-equipped hospital with an experienced team that handles complex cases.
A neonatal intensive care unit (NICU) must be available in case of complications.

✔ Careful Monitoring Before and After the Procedure

Ultrasound and Doppler scans to monitor fetal well-being.
Hemoglobin testing to determine if additional blood transfusions are needed.

✔ Ensuring Complete Blood Compatibility

Using fully compatible donor blood free from antibodies to prevent fetal rejection.

✔ Complete Bed Rest for the Mother After the Procedure

Avoiding any physical exertion for the first 24 hours.
Monitoring for any abnormal symptoms like bleeding or severe pain.

Nursing Care After Intrauterine Blood Transfusion

Monitoring the Mother After the Procedure

✔ Bed Rest

The mother should lie down for at least 2 hours post-procedure.
Avoid sudden movements for the first 24 hours.

✔ Vital Signs Monitoring

Blood pressure, heart rate, and temperature should be checked every 15–30 minutes during the first two hours.
Ensuring no vaginal bleeding or severe contractions occur.

✔ Pain Management

Mild cramps or slight discomfort are normal, but severe pain requires immediate medical attention.
Safe pain relievers may be given after consulting the doctor.

✔ Observing for Abnormal Symptoms

Any vaginal bleeding, amniotic fluid leakage, severe contractions, or dizziness should be reported immediately for urgent medical intervention.

Monitoring the Fetus After Blood Transfusion

✔ Checking Fetal Heartbeat via Ultrasound

In the first few hours, the fetal heartbeat is monitored to ensure no adverse effects from the procedure.
Temporary heart rate fluctuations may occur but typically resolve with observation.

✔ Tracking Fetal Movements

The mother should observe fetal movements after the procedure.
If movements become weak or absent, she must inform the doctor immediately.

Follow-up Ultrasound After a Few Days

A Doppler ultrasound is performed 3-7 days after the transfusion to ensure the transfused blood is being properly utilized and that fetal anemia is improving.

Preventing Complications

✔ Preventing Infections

Proper care of the needle insertion site to avoid infection or inflammation.
If the mother experiences high fever or chills, she should see a doctor immediately.

✔ Preventing Preterm Labor

If preterm birth is a risk, the doctor may recommend a corticosteroid injection to accelerate fetal lung development.
Monitoring for unusual uterine contractions and ensuring complete rest.

✔ Preparing for Another Blood Transfusion Session

Some fetuses require multiple transfusions, so a new session may be scheduled within 2-4 weeks, depending on the condition.

Maternal Health Education

✔ Emphasizing the importance of regular follow-ups after the procedure.
✔ Teaching the mother how to monitor fetal movements daily and report any decrease to the doctor.
✔ Advising on rest, avoiding excessive exertion, and reducing stress.
✔ Reminding the mother to attend all scheduled ultrasound appointments as prescribed by the doctor.

When to Contact a Doctor Immediately After an Intrauterine Blood Transfusion?

After an intrauterine blood transfusion, both the mother and fetus require close monitoring. Some symptoms may indicate a serious problem, so the mother should contact the doctor immediately or go to the hospital if any of the following signs appear:

1. Heavy Vaginal Bleeding

✔ When is bleeding considered dangerous?

If there is heavy bleeding similar to or more than a menstrual period.
If there are large blood clots present.
If the bleeding continues for several minutes without stopping.

✔ Possible Causes:

Injury to the placenta or umbilical cord due to the needle insertion.
Partial placental abruption, which is very dangerous for the fetus.
Injury to the uterine wall during the procedure.

✔ What should you do?

Go to the hospital immediately for an ultrasound to check the placenta and fetal well-being.

2. Severe Abdominal Pain or Strong Uterine Contractions

✔ When is the pain abnormal?

If the pain is persistent, severe, and does not improve with rest.
If it is accompanied by bleeding or fluid leakage.
If the pain starts as a mild cramp but intensifies significantly, resembling labor pains.

Who Performs an Intrauterine Blood Transfusion?

This procedure is typically performed by a specialist in obstetrics and gynecology, particularly doctors with expertise in managing high-risk pregnancies and fetal medicine.