RH Sensitization Success Story: Will You Share? - Dr. Lam

Dr. Lam:
When Melissa came to see us, and my partners, at the maternal-fetal center she was known to have a baby that was affected with RH sensitization. So what happened was, Melissa had three bleeds in this pregnancy and what had happened was the baby’s blood was thereby recognized by Melissa’s immune system as foreign so Melissa developed antibodies to the baby’s blood. As a result, her antibodies were thereby destroying and killing off the baby’s red cells.

When this happens the baby can become severely anemic and even potentially what we call hydropic or start to fill with fluid within the body cavity because the baby’s not getting enough blood and circulation to allow for healthy tissue development. When this happens, babies can die in-utero. The only way to save babies such as this is to do something called percutaneous umbilical blood sampling and fetal intrauterine transfusion.

In this process what we do is we screen the baby with an ultrasound first and we measure the blood flow through the baby’s brain, something called a MCA Doppler, the middle cerebral artery Doppler, okay? What this does is that if a baby is anemic, the baby’s going to want to preserve the brain so it’s going to shunt a lot of blood flow to the brain and thereby we are going to measure faster blood flow through the brain than normal and that’s going to imply that the baby has a low blood count.

If that happens, then we have her come to maternal-fetal center and we perform an in-utero therapy procedure called a percutaneous umbilical blood sampling and fetal intrauterine transfusion. In this setting, what we do is we use an ultrasound to look for the baby’s cord insertion into the placenta, and through ultrasound guidance we place a needle through mom’s abdomen through her uterus directly into the baby’s umbilical cord, and we try to access the blood vessel within the umbilical cord and actually transfuse fresh blood into the baby to help bring it’s blood count back up.

This procedure can be done as early as 16-18 weeks all the way up to about 33 weeks. It can be a very touchy procedure because we are essentially using a needle that is about, we use about a 20-gauge needle, which I guess is about the thickness of what you use for a pushpin and we try to access a blood vessel that might be the size of a mechanical pencil lead and then by doing this we can channel blood into the baby.

Oftentimes in doing this we may need to do two, three, sometimes even four procedures as long as it takes to keep baby’s blood count up regularly and to allow baby to continue to develop and grow within mom.

Well I believe Melissa was scared. She hadn’t gone through anything such as this before and unfortunately procedures, when we work in-utero, are not without risk and especially because we are dealing with a very compromised baby there can be the risk of death of the fetus in the womb up to about anywhere from one to five percent from these procedures, or if we don’t do this, the risk of the baby dying without treatment is much, much higher and well over 50%. So this is a gamble that she had to weigh and she found worth undertaking in order to help this baby survive.

With this pregnancy, Melissa had three transfusions and she started off coming to see us back in mid-March. So she was basically about 26 weeks along at that point and she had transfusions about every two weeks that brought her up to about 33 weeks.

With this last transfusion, it went very, very smoothly and with no complications but because it’s always such a risky procedure, because we are invading the baby’s blood cells and invading the placenta, we always keep moms overnight for observation to make sure the babies were doing well.

After this last procedure, the baby had intermittent D-cells or drops in his heart rate and sometimes that can imply that the baby’s not getting enough oxygen perhaps maybe because the placenta isn’t working very well. So we kept her a little bit longer and she ended up staying for up to three days after her procedure, which is a little bit longer than usual.

It ended up that the baby then started to show more and more stress and started to have more and more dips in the heart rate so we had to decide to deliver the baby on the early side in order to preserve the baby’s survival overall and luckily, we have a very healthy 34-week baby with us.

Yeah, the best news to me is that our patients have a healthy baby that they’ll be able to take home and Melissa right now is recovering well. In fact, she is ready to go home today. The baby will probably be here a little bit longer to grow and make sure that it’s doing well because it is a little bit premature, but it sounds like it’s doing tremendously well in the nursery.

About Dr. Garrett K. Lam, M.D.:
Dr. Garrett K. Lam is board certified in both Obstetrics and Gynecology and Maternal Fetal Medicine. He received his MD from the University of Rochester, completed his residency training at Banner Good Samaritan Medical Center, then went to the University of North Carolina-Chapel Hill for his fellowship in Maternal Fetal Medicine.

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