Fetal Therapy for Fetal Problems

The most common indications for intrauterine transfusion (IUT) are red cells for prevention and treatment of fetal anaemia due to haemolytic disease of the fetus and newborn (HDFN) or parvovirus infection and platelets for neonatal alloimmune thrombocytopenia (NAIT).

This is a highly specialised area of medical practice requiring close collaboration between experts in fetal medicine, haematology and blood transfusion, and rapid access to blood counting. Even in the most expert hands IUT carries a risk of fetal death of 1–3% per procedure and feto maternal haemorrhage may cause further sensitisation and worsening of HDFN.

In Rh isoimmunised pregnancies the objective of IUT is to prevent or treat life-threatening fetal anaemia (hydrops fetalis) and allow the pregnancy to continue to a stage where a viable baby can be delivered (ideally at least 36 weeks gestation). High-risk pregnancies are monitored by weekly fetal Doppler ultrasound scans to measure middle cerebral artery peak systolic velocity, an indication of the severity of fetal anaemia, and regular ultrasound monitoring of fetal growth.

With a twin gestation most parents are stuck with joy and fear together. The incidence of complications in multiple pregnancy are high and moreover in those fetuses who share the placenta( monochorionic pregnancies).Complications that might occur are difference in growth between the twins, one baby getting more blood than the other baby (TTTS),anomaly in one baby affecting the survival of affected baby which leads to risk to the other baby(brain damage) when the affected baby gives up inside the mother’s womb.

Radiofrequency ablation seems to be a promising and upcoming technique in managing complex monochorionic pregnancies in resource limited settings. In this procedure radio frequency is used to stop the blood flow to the affected baby thus making an unaffected survival of the healthy baby. This is done by inserting a needle into the mother’s womb to the affected fetus under the guidance of the ultrasound and heat is generated using a machine which blocks the blood flow in the affected baby.

This procedure is also being offered in triplet pregnancies where two babies share one placenta and the other baby has a different one altogether. This procedure gives the couple the option of continuing the pregnancy as twins rather than reducing the pregnancy to singleton as a regular chemical reduction cannot be used.