Intra-Uterine Transfusion in a County Obstetric Service

Abstract

A review of 46 patients treated by intra-uterine transfusion on account of Rhesus isoimmunisation from a County Obstetric Service is given. The patients treated were those considered to have a very high risk of intra-uterine death before the 34th week of pregnancy. The main criteria for their selection were liquor amnii optical density readings at 450n. in the upper part of a Liley type prediction graph or an initial reading in the upper part of the middle zone with a subsequent reading rising steeply towards or entering the upper zone. Amniocentesis was usually carried out at 29 and 31 weeks' gestation but, in cases with a history of previous stillbirth or neonatal death, it was carried out at 25 weeks and repeated as necessary. The technique which evolved in the light of experience and with a view to minimal radiation exposure is described in detail. There were 18 surviving babies out of 46 cases giving a survival rate of 39.1 per cent. Of these 18 surviving babies 17 were perfectly normal on follow-up but one is spastic, probably due to an anoxic episode during an exchange transfusion. No maternal ill-effects, which could be definitely attributed to the procedure, were encountered.