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How Fetal Medicine put the smile back on bereaved mother by Dr. Shreyasi Sharma

Published by Medikoe


Rh isoimmunization is not a term that you come across every day, but it is a nightmarish condition to expectant mothers. Rh isoimmunization is a condition where the lady has Rh Negative blood group and her body develops anitibodies against Rh positive blood groups. When this lady carries a child who has a Rh positive blood group, then the antibodies attack the blood cells of the Foetus, causing Fetal Anemia. This can cause devastating effects for the foetus such as cardiac failure and Fetal death in utero.

Rh isoimmunization is usually identified by checking for Fetal Anemia. Fetal anemia is diagnosed through ultrasound by checking blood velocity in the Fetal Brain (middle cerebral artery peak systolic velocity).

Quite recently, I encountered a lady presented with the Rh Isoimmunisation condition in the 25th Week of Pregnancy. She has a living child and had a fetal demise in the previous pregnancy due to Rh isoimmunization. Ultrasound suggested Fetal Anemia with fluid accumulation in the abdomen to the foetus. The couple was counseled adequately about the need of intra uterine blood transfusion to the fetus, to which they agreed. The first blood transfusion was done within 48 hours.

Fetal Blood Transfusion is an extremely challenging procedure, where under continuous ultrasound guidance access is gained into the umbilical cord vein. The challenge is to continuously maintain that access till the transfusion is completed to the fetus. Any inadvertent movement of the needle can amount to fetal loss. The calculation of the blood to be transfused must be precise as over transfusion has its ill effects and under-transfusion would mean suboptimal treatment.

The first blood transfusion was performed seamlessly in a single attempt without any complication. But, destruction of blood cells (hemolysis) is an ongoing process and the pregnancy was just 25 weeks. The patient was kept under constant monitoring using the same fetal brain blood flow velocity used to diagnose Fetal Anemia (middle cerebral artery peak systolic velocity). We were compelled to do the next transfusion within a week, at 26 weeks due to strong ongoing hemolysis. In all, we did 5 intrauterine blood transfusions and successfully sustained the pregnancy till 34 weeks. Labour was induced and the lady delivered young Araansh (name changed) with a birth weight of 2.9 kg.

The bundle of joy is now over 6 months old and continues to drench everyone around him in happiness. While I cannot discount the challenging complexity around this episode, restoring the smile on the face of the mother counts to be one of the most satisfying moments in my experience as a fetal medicine expert. It reminds me of the burden and the beauty of the amazing practice called Fetal Medicine.

About the author:

Dr. Shreyasi Sharma, a multiple award-winning Fetal Medicine expert, currently works as Fetal Medicine Consultant at CK Birla Hospital for Women, Gurgaon. She completed her MD in Obstetrics and Gynaecology from the prestigious PGIMER, Chandigarh and holds a fellowship in Fetal Medicine from Apollo Centre for Fetal Medicine. She is Fetal Medicine Foundation (FMF UK) certified in 11-13+6 weeks scan, anomaly scan, dopplers in obstetrics and cervical assessment. Her special areas of interest are screening for preterm labour, fetal growth restriction, Rh isoimmunisation, diagnostic and therapeutic fetal procedures and clinical genetics.

CK Birla Hospital for Women is a multi-specialty hospital chain focused on holistic wellness of women. It is part of the $1.8 billion diversified CK Birla Group. The hospital’s Gurgaon setup, spread over 78,000 sq ft, is a 70 bed facility with ICUs, a 15 bed level 3 NICU, SCBU, 5 modular operating theatres, 38 spacious patient rooms and suites with all amenities, outpatient rooms, advanced labour and recovery rooms, state-of-the-art diagnostics, an advanced IVF unit with a Modular Egg collection theatre, Andrology Lab, IVF Lab, IUI/Embryo Transfer facility and a Cryo Store.