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Oxford University Hospitals NHS Foundation Trust
Maternity

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Fetal transfusion

A fetal transfusion is a life-saving procedure for unborn babies suffering from a condition which destroys their blood.

Why is this done?

The majority of fetal transfusions are performed for two reasons.

Haemolytic disease of the fetus: this is a condition where the mother produces blood cell antibodies which cross the placenta and destroy the baby's blood. Fetal transfusion is sometimes necessary for the pregnancy to continue until term. The condition will resolve after the baby's birth, when the baby is no longer exposed to the harmful antibodies.

Infection: the commonest infection is from a virus named parvovirus B19. This virus causes a harmless infection in most children and adults called 'slapped cheek'. However, when a pregnant woman contracts parvovirus, there is a 1 in 20 chance that the baby may suffer severe anaemia as a result. The baby might require a fetal transfusion, but in most cases the infection will resolve without other consequences.

How is a fetal transfusion performed?

This is performed as a daytime procedure under local anaesthetic and does not usually require hospital admission.

A couple of days before the procedure you will have a blood test so that our blood bank can select and prepare the appropriate blood type for your baby's transfusion. On the day of the transfusion we will offer you an antibiotic injection in order to minimise the risk of infection.

The procedure will be performed under direct ultrasound vision. The fetal medicine specialist will introduce a thin needle through the skin of your tummy into a blood vessel of the umbilical cord.

The baby's blood count will be measured before the start of the transfusion in order to estimate how much blood is needed, and also at the end in order to confirm that the correct volume of blood was given.

When transfusions are performed for haemolytic disease, a repeat transfusion is often needed every two to four weeks until the baby's birth. Less common types of transfusion are directly into the baby's heart (intracardiac) or inside the baby's tummy (intraperitoneal).

What are the risks of a fetal transfusion?

According to the UK Blood Transfusion and Tissue Transplantation Service, fetal transfusion is a highly specialised area of medical practice requiring close collaboration between experts in fetal medicine, haematology and blood transfusion.

Even in the most expert hands it carries a risk of fetal death in one to three of every 100 procedures. This risk is higher when the baby is very sick at the start of the procedure (a condition called hydrops), or when the procedure is performed due to parvovirus infection.

Because this is an invasive fetal procedure, there is also a risk of premature birth.

Our fetal transfusion service

Our current team of specialists has delivered fetal transfusions in Oxford for over 15 years.

Between 2012 and 2018 we performed 115 transfusions without any procedure-related complications. 91 transfusions were carried out for haemolytic disease of the fetus, which were all successful.

We have also performed 22 transfusions in 14 babies due to hydrops from infection: these transfusions were uncomplicated but there were two stillbirths due to worsening consequences of the underlying infection.

We have also performed two transfusions for other rare conditions.