Intrauterine Fetal Transfusion

Nicholas Teodoro; Leanna Sudhof; Scott A. Shainker

doi:10.1542/neo.20-10-e612

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Questions

A woman is pregnant at 31 weeks’ gestation with Rh (D)–negative, antibody-negative blood type. She develops a placental abruption, prompting delivery of a viable preterm infant with Rh (D)–positive blood type. Which of the following is recommended after delivery to prevent D-alloimmunization in the mother?
- A. Administration of Kell immune globulin at the time of delivery will prevent Rh (D) alloimmunization.
- B. Administration of Rho (D) immune globulin within 3 days will prevent Rh (D) alloimmunization.
- C. Maternal treatment is only needed if the infant’s blood type is Rh (D) negative.
- D. There is no treatment available to prevent Rh (D) alloimmunization.
Unfortunately she does not receive the appropriate treatment. She then has a miscarriage while traveling and has an extremely elevated anti-D antibody titer in her next pregnancy 2 years later. She is diagnosed with fetal anemia at 22 weeks’ gestation and ultimately has a procedure (Video 1). What procedure is being shown in this video?
- A. Fetal umbilical vein transfusion
- B. Intraperitoneal transfusion
- C. Rho (D) immune globulin administration
- D. Termination of pregnancy because of expected severe outcome

Video 1.

Click here to view the video. Fetal intraperitoneal transfusion.

Discussion

Alloimmunization is the development of antibodies to foreign red blood cell antigens. Fetal red blood cell antigens are determined by maternal and paternal red blood cell phenotypes. If the fetus expresses antigens foreign to the pregnant woman, the woman can develop immunoglobulin G (IgG) antibodies to …