Advances in perioperative management of intrauterine blood transfusion

Abstract

With the fast development of fetal medicine in China, intrauterine transfusion, which is regarded as an effective treatment in certain conditions, has attracted more and more attention. In addition to the common seen red blood cell alloimmunization, the indications of intrauterine transfusion include parvovirus B19 infection, maternal-fetal blood transfusion syndrome, twin anemia-polycythemia sequence, placental chorionic hemangiomas and fetal sacrococcygeal teratomas. The recommended approach for intrauterine transfusion is umbilical vein or intraperitoneal transfusion depending on the gestational age, placental location, and presence of absence of fetal edema. However, umbilical artery and intracardiac transfusion are not recommended. In order to reduce the complications of intrauterine transfusion, routine fetal analgesia, avoidance of umbilical artery puncture and prior use of intrahepatic umbilical vein transfusion are recommended. Fetal middle cerebral artery-peak systolic velocity (MCA-PSV) >1.5 multiple of median (MOM) and 1.69 MOM can be a good indicators for the first and second intrauterine transfusions, respectively. For the third and subsequent transfusions, the rate of fetal hemoglobin decline is recommended to predict the timing of transfusion. Key words: Blood transfusion, intrauterine; Perioperative period; Fetal hemoglobin