Procedure:

• The abdomen is aseptically prepped.
• A 20-guage,5-inch spinal needle is then guided into the umbilical vein at the placental insertion under ultrasound guidance.
• Fetal blood is aspirated for immediate hematocrit, CBC, blood type and Rh factor.
• Prior to transfusion pancuronium bromide may be administered as an IV bolus.
• Transfusion is performed using type O, Rh-negative, CMV-negative, washed irradiated packed cells, cross-matched against maternal blood.
• The volume of donor blood to transfuse may estimated using the calculator below.

Donor hematocrit ( 75%)  Initial fetal hematocrit  Final fetal hematocrit (~45%)  EFW (grams)

Volume RBCs to transfuse  (mL)  (Typical transfusion volume is 30 to 100 ml)

Dosage of pancuronium  (mg)

• The donor blood is infused at 3-5 mL/min.
• Fetal blood is aspirated at the the conclusion of the transfusion to determine final fetal hematocrit.

  REFERENCES
  1.  Socol ML, MacGregor SN, Pielet BW, Tamura RK, Sabbagha RE. Percutaneous umbilical transfusion in severe rhesus isoimmunization: resolution of fetal hydrops. Am J Obstet Gynecol. 1987 Dec;157(6):1369-75. PMID: 3122574; UI: 88103789
  2.Pielet BW, Socol ML, MacGregor SN, Dooley SL, Minogue J. Fetal heart rate changes after fetal intravascular treatment with pancuronium bromide.Am J Obstet Gynecol. 1988 Sep;159(3):640-3.PMID: 3421263; UI: 88338648
  3. Rodeck CH, Nicolaides KH, Warsof SL, Fysh WJ, Gamsu HR, Kemp JR. The management of severe rhesus isoimmunization by fetoscopic intravascular transfusions.Am J Obstet Gynecol. 1984 Nov 15;150(6):769-74. PMID: 6437228; UI: 85044018