Absorption of fetal intraperitoneal blood after intrauterine transfusion.

Abstract

We reviewed the sonograms and medical records of all patients who underwent intrauterine transfusions between December 1981 and December 1984 in order to determine the time course for disappearance of the intraperitoneal blood. Seventy-two sonographic examinations were performed on 22 patients who underwent 51 intrauterine transfusions. Nonhydropic fetuses who received s 50 cc of intraperitoneal blood exhibited no ul· trasonic evidence of intraperitoneal fluid after 8 days.U ltrasonography has become an integral part of the management of Rh isoimmunized fetuses.1.2 The severity of disease and possible progression toward the hydropic state may be followed using ultrasound evaluation. Recently, real-time ultrasound has played a major role in performing intrauterine transfusion for severely affected fetuses. 3 After the intrauterine transfusion, ultrasound is also useful to follow the clinical course of the fetus.· A consideration in the management of these patients is the time course for absorption of the transfused blood. Since ultrasound is capable of identifying transfused blood in the fetal peritoneal cavity, we reviewed our experience with ultra 7 sound-guided intrauterine transfusions to determine the normal time course for disappearance of the intraperitoneal blood. MATERIAL AND METHODSWe reviewed the medical charts and ultrasound examinations of all patients who had intrauterine transfusions at our institution between December 1981 and December 1984. Ultrasound examinations were performed on commercially available real-time equipment.Twenty-two patients underwent 51 intrauterine transfusions during this time period. The decision to perform an intrauterine transfusion was based upon the optical density at 450 u (600450) of the patient's amniotic fluid. Patients with 600450 rising to zone III of the Liley graph were candidates for intrauterine transfusion. 2 Hydropic fetuses were not excluded. Seven fetuses had hydrops with ascites.The fetuses who had intrauterine transfusions ranged from 18 to 32 menstrual weeks. The volume of packed red blood cells injected at each intrauterine transfusion was based upon fetal age. l If {etal ascites was present prior to an intrauterine transfusion, as much of the peritoneal fluid as possible was aspirated before the packed red blood cells were injected.The fetal abdomen was observed using real~time ultrasound during all intrauterine transfusions. Intraperitoneal packed red blood cells initially may appear echo-

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