Grab your coffee and eat your Wheaties wombmates! We’ve finally made it to our favorite topic – Intrauterine Transfusions! We love this topic so much we had to split it into two parts to cover everything we wanted to. This week we'll cover the background and leading up the procedure itself, then next week we'll go into more detail about the procedure itself. See the topic list below for part 1 and stay tuned next week for part 2!
- The 4 types of IUTs: intravascular (IVT), intraperitoneal (IPT), combined, and intracardiac
- When does a patient need an IUT?
- Timing of IUTs – when we start, the latest we’ll do them, and how often
- Common complications such as fetal bradycardia and options for treating it
- Donor blood preparation – extended maternal crossmatch, CMV negative, irradiated, leukocyte reduced, and washed
- How long the procedure lasts and where it takes place
- What type of anesthesia we use for Mom in IUTs (conscious sedation)
- Why we don’t use fetal Lasix (furosemide) for fetal hydrops in the setting of HDFN
- Formulas!
- IVT = volume of donor blood (78-80% hct) to raise the fetal hct 10 points = 0.02 x EFW (in grams)
- IPT = (GA (in weeks) – 20) x 10
- Fetal vecuronium dose = EFW x 0.1 mg/kg
- Fetal fentanyl dose = EFW x 2 mcg/kg
- Fetal atropine dose = EFW x 0.02 mg/kg
- Abbreviations Key:
- EFW = estimated fetal weight
- GA = gestational age
- IUT = intrauterine transfusion
- IVT = intravascular transfusion
- IPT = intraperitoneal transfusion
- Hct = hematocrit
- HDFN = hemolytic disease of the fetus & newborn
- MCA = middle cerebral artery
- MoM = multiples of the median
