Radiological Aspects of Intra-uterine Blood Transfusion

Abstract

Direct intra-uterine transfusion of the fetus, for the treatment of rhesus iso-immunization, was performed in 23 single babies and 3 sets of twins. Needling under radiological control was performed 49 times. Cases were selected on the basis of an obstetric history of babies affected by hemolytic disease and by spectrophotometric analysis of the liquor. Only those babies in whom intrauterine death before the 34th week of pregnancy was considered a likely outcome were chosen for transfusion. The technique consisted of introducing O Rh negative red cells into the fetal peritoneal cavity where they were absorbed directly into the circulation and could combat the anemia which it is felt the underlying basis of erythro-blastosisetalis. An attempt was made to opacity the fetus the night before the radiographic part of the procedure, to facilitate needling in the X-ray department. A preliminary film was taken with markers, and then needling of the baby''s peritoneal cavity under fluoroscopic control was undertaken. When a test injection of contrast medium suggested that the needle was correctly positioned, a catheter was threaded down the needle which was then removed. The catheter was opacified and a check film taken to confirm that it lay in the peritoneal cavity. A blood transfusion was then given after aspirating any ascitic fluid. The catheter may be left in situ but its position must be checked by radiography before further transfusions can be made. Of the 29 fetuses transfused on one or more occasions 10 were still-born, and of the 17 live births 10 survived. In all live births, transfused cells could be demonstrated in cord blood.