Intraperitoneal transfusion in severe, early-onset rh isoimmunization

OBJECTIVE: To describe the management of five women with severe, early-onset Rh isoimmunization with a series of intraperitoneal transfusions. METHODS: Intraperitoneal transfusions were started at 15 to 16 weeks of pregnancy, with small volumes of blood given weekly until the umbilical cord could be successfully entered and further transfusions given intravascularly. RESULTS: The initial range of anti-D immune globulin levels was 24-244 international units, and all women had severe Rh isoimmunization complicating previous pregnancies. No fetus was severely anemic at the first intravascular transfusion (lowest hemoglobin 8.9g/dL), and there were no fetal losses. Middle cerebral artery peak systolic velocity responded to treatment with intraperitoneal transfusions, suggesting that even at 15 to 16 weeks of gestation it correlates with fetal hemoglobin. CONCLUSION: This series shows that intraperitoneal transfusions can be used to successfully treat severe, early-onset Rhesus disease. LEVEL OF EVIDENCE: II