Annals of the National Academy of Medical Sciences (India) (Jan 2018)
Fetal Blood Transfusion: The Saviour
Abstract
The purpose of this oration is to discuss the modality of highly specialized Intra vascular fetal blood transfusion and its various sites to perform fetal blood transfusion with the role of middle cerebral artery-peak systolic velocity (MCA-PSV), as measured by Doppler ultrasound, in managing fetal anemia in Rh-alloimmunized pregnancies. Intra-uterine fetal blood transfusion was performed in such anemic fetuses to tide over the crisis of fetal immaturity till considered fit for extra-uterine survival. Rh-alloimmunized pregnancies with or without hydrops reporting to our tertiary care institute from January, 2005 to December, 2015 were screened by Doppler ultrasound to estimate MCA-PSV to detect fetal anemia. During follow-up, if the fetus developed MCA-PSV values more than 1.5 MoM for the gestational age, fetal blood sampling through cordocentesis was performed to confirm fetal anemia. This was followed by intra-uterine fetal blood transfusion to all the anemic fetuses at the same sitting. The neonatal outcome was evaluated by recording gestational age at the time of delivery, duration of gestational time gained, and need for blood transfusion in the neonatal period. A total of 226 Rh-alloimmunized pregnancies were evaluated. Three hundred ninety six intra-uterine fetal blood transfusions were performed. In their neonatal period, 137 neonates received blood transfusion. Intrauterine fetal death occurred in 11 fetuses out of which 7 were grossly hydropic fetus. Favorable neonatal outcome was recorded in the rest including 42 hydropic fetuses. The clinical outcome of these pregnancies justifies the use of Doppler studies of MCA-PSV in detecting fetal anemia as these were found to correlate well. Intra-uterine fetal blood transfusion in the anemic fetuses is the only hope of prolonging pregnancy salvaging such fetuses.
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