Molly and Bethany discuss the when and how of intrauterine blood transfusions (IUTs). Bethany, possibly the world record holder for number of IUTs, has had 16 IUTs through her four allo affected pregnancies. IUTs come with their own risks, but in the hand of a trained and experienced doctor they are the most effective way to maintain the health of an anemic baby.

Episode themes: 

• Likelihood of needing an IUT
• When to perform an IUT (before hydrops is present)
• IUT procedure before, during and after
• Medications used during an IUT
• Spacing of IUTs when multiple are required
• Outcomes of IUTs in a skilled facility
• Tips for patients and clinicians

Questions for your MFM discussed in this episode: 

• How many IUTs do you do per year?
• How often do you do them?
• How many did you do last year?
• What is your success rate?
• Have you ever lost a baby to the procedure?
  • How many?
• Do you perform the IUT in an operating room?
• Do you provide mom with conscious sedation?
• Do you paralyze the baby for the IUT?
• Walk me through the procedure
• What does the monitoring look like after the IUT is finished?
• What do you use to decide when to space IUT?
• When do you do the last one in general?
• How early have you done them?
• Are you willing to refer me to a different MFM for IUTs if necessary? 

Other Tips

• Have a friend or partner there with you when you get an IUT. 
• Communicate constantly with your nurses, doctors, and anesthesiologist 
  • Communicate needs and anxieties
• Speak up about your needs and comfort 
• Ask for and record the beginning and ending hematocrit 

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

• IUT: Intrauterine transfusion: using a needle through the mom’s belly to insert blood into the umbilical cord or abdomen of an anemic fetus. 
• Cordocentesis: a test done during the IUT process that determines that a fetus is definitely anemic before transfusing blood. 
• Ascites: fluid collecting in the abdomen of a fetus, a sign of fetal hydrops. This is a sign of critical distress and blood should not be infused into the abdomen. 
• IVT: Intravascular transfer: an IUT where the blood is transferred into the umbilical cord vein and therefore directly into the baby’s vascular system, treating the anemia right away. 
• IPT: intraperitoneal transfusion: transferring blood into the abdomen of a baby. Usually reserved for early gestation before an IVT is possible. Blood is later absorbed into the system when the baby needs it. Not to be done when baby shows signs of fetal hydrops. 

Guests: Dr. Ken Moise https://partnersincare.health/directory/kenneth-moise

Dr. Thomas Travett http://www.georgiaperinatal.com/dr-trevett/

Links mentioned in this episode: 

Canada Study on how often alloimmunized women need IUTs: https://onlinelibrary.wiley.com/doi/pdf/10.1111/trf.16061?casa_token=oeYAk0MeFNsAAAAA:LxM4QAUDqnTuadhT6Ya7gZrtZ5pMv1GzwtLdJGxIHOOglSCgdN-GzjhNfMXv7EwklB1q8n9-d4sT5iE

Dr. Moise’s article on UpToDate: https://www.uptodate.com/contents/intrauterine-fetal-transfusion-of-red-cells?search=interueteran%20transfusion&source=search_result&selectedTitle=6~150&usage_type=default&display_rank=6

Leiden retrospective analysis after 1678 IUT procedures: https://obgyn.onlinelibrary.wiley.com/share/MB8MU3HPWYVXSCUMIE7G?target=10.1002/uog.17319

Study on steroids affecting MCA scans: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411792/

Redheads need more anesthesia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362956/

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org.

The Allo Podcast is produced and edited by https://www.mediaclub.co.