Intrauterine treatment of severe fetal erythroblastosis: intravascular transfusion with ultrasonic guidance.

Twenty intrauterine, intravascular transfusion were performed in six patients under ultrasound guidance, the earliest one in the 19th week of gestation. In all twenty attempts we were able to insert the needle into the umbilical vein, transfuse between 12 and 80 ml of packed red blood cells, and raise the hematocrit (HK) up to 57% maximally. In two cases the fetal hydrops and the ascites completely disappeared. There was one complication in case 6. Fetal bradycardia developed after transfusion of 70 ml packed red cells in the 30th week. An immediate Caesarean sections was performed. The fetus was in a good condition and developed normally. All other fetuses were born by Caesarean section between 33 and 36 weeks of gestation and have had normal development up to now. These results show that the intrauterine, intravascular application of red blood cells is superior to the intraperitoneal approach. By the direct insertion into the cord the risk of fetal lacerations is minimal. On the other hand overtransfusion may occur more easily.