Fetal transfusion.

In the Rh-sensitized pregnancy, direct treatment of the fetus has been practiced for over two decades. Although Rh immune prophylaxis has markedly decreased the incidence of Rh sensitization, there are still fetal deaths due to this disease. Current management of the severe form of Rh disease includes serial transabdominal intrauterine transfusions, preterm delivery and intensive neonatal care. Heart failure in the fetus may be treated by administering medications to the mother. Ascites or pericardial effusion are easy to detect with ultrasound imaging. Digoxin and diuretics have been used to reverse the ultrasound evidence of fetal congestive heart failure. Recently, direct fetal intravascular transfusion by fetoscopy has proven effective. In some instances, hydrops fetalis appears to be reversed by such transfusions. The use of promethazine and plasmapheresis have only limited success in ameliorating the disease in the fetus.