Double/Triple Intrauterine Blood Transfusion in Rh-isoimmunized Anemic Fetuses in Multiple Pregnancies with Favorable Outcome.

Content Provider	Europe PMC
Author	Bansal, Vandana Jayaprakash, Meera Gangurde, Akshay
Abstract	Background Multiple pregnancies have increased with the use of assisted reproduction, and we expect more women reporting with Rh isoimmunization among multiple gestation in near future. Intrauterine transfusion in singleton itself is technically difficult and requires a lot of skill and precision. Performing double/triple transfusion in twins/triplets is expected to be more demanding. Aim To create awareness on the technical difficulties encountered in intrauterine transfusion in twins and triplets. Methodology We report a case series of four Rh-isoimmunized twins/triplets in 5 years who presented with severe anemia requiring intrauterine transfusion. Results Each of the four sets of cases had their own intricacies that needed to be pondered before tackling them as not much was available in the literature. In Case 1, the first twin intrauterine transfusion in our 20-year-long experience, the difficulty in the approach to the first twin due to a posteriorly placed placenta has been highlighted. Case 2 was rare due to the concomitant presence of atypical antibodies in the mother in addition to Rh-D isoimmunization that made it difficult to cross match any donor blood for intrauterine transfusion. The third case was exclusive due to its monochorionic–diamniotic nature of the twins where the impact of inter-twin anastomosis on the transfusion was to be taken into consideration. Fourth case was a triplet gestation where the difficulty of which cord to be assigned to which fetus, the crowded space for intervention, as well as the risk of prolonged operative time and associated risk of preterm/premature rupture of membranes were our concern. Conclusion Intrauterine transfusion (IUT) in twins/triplets is challenging. Difficulties encountered during IUT in multifetal gestation are due to different or uncertain chorionicity, intraplacental anastomosis between vessels, different degree of anemia in twins, difficult to ascertain cord–fetus relationship and difficulty to reach placental insertion site due to crowding by multiple fetal parts.
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ISSN	09719202
Volume Number	73
DOI	10.1007/s13224-023-01746-y
PubMed Central reference number	PMC10616019
Issue Number	5
PubMed reference number	37916049
Journal	Journal of Obstetrics and Gynaecology of India [J Obstet Gynaecol India]
e-ISSN	09756434
Language	English
Publisher	Springer India
Publisher Date	2023-03-25
Publisher Place	New Delhi
Access Restriction	Open
Rights License	© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
Subject Keyword	Fetal anemia Intrauterine transfusion Rh isoimmunization Twin transfusion Twin intrauterine transfusion
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology