Special report
A novel and innovative method to detect and avoid complications before the birth of the newborn was recently developed at the Social Security Fund (CSS), by a multidisciplinary team made up of staff working in the Maternal-Fetal Medicine service, Department of Nursing and maternity hospital at Irma De Lourdes Tzanetatos Hospital. The method called “intra-uterine transfusion” provides blood to an Rh-positive fetus when the fetal red blood cells are being destroyed by Rh antibodies.
This procedure involves performing a blood transfusion to replace fetal red blood cells that are being destroyed by the immune system of the mother who has Rh sensitization, whose treatment aims to keep the fetus healthy until it is mature enough to be born.
Dr. José Leonardo González, national head of the Maternal and Child Program of the CSS, explained that the institution has Doppler ultrasound equipment, which allows observing through these devices, the systolic peak of the fetus’ middle cerebral arteries, if they are developing or not, anemia.
“We have a multidisciplinary team of subspecialists in maternal-fetal medicine that the CSS has, who are dedicated to carrying out these controls and once moderate or severe conditions of fetuses are detected, they proceed to assess whether or not they apply for surgical treatment,” said.
Dr. González added that to carry out this procedure, they had the case of a 31-year-old patient with a 28-week pregnancy, who developed a picture of “Rh isoimmunization”, which required this surgical procedure. and in this way they proceed to carry out an intrauterine fetal transfusion, something new that is carried out in the public health system with Panamanian specialists, and they seek to guarantee that this child can improve his hemoglobin levels, and at the time of birth, he is not born with the complications that could occur due to the decrease in hemoglobin.
“And in coordination with the Specialized Laboratory of the Blood Bank of the Hospital Complex, which prepared the blood package in a special way and thanks to the operating rooms that we have at the Irma de Lourdes Tzanetatos Hospital, the blood transfusion to this patient was successfully performed. fetus”, the specialist said.
Surgical intervention
Regarding this process, Dr. Nelson Leonel Ortega de la Cruz, a specialist in Fetal Medicine at the “Dr. Arnulfo Arias Madrid”, explained that the surgical intervention consisted of inserting a needle through the patient’s belly, where part of the skin and subcutaneous tissues were pierced to reach the uterus and be able to cross the placenta until reaching the umbilical vein, where Samples were taken and it was confirmed that the fetus had a hemoglobin of 3.9, a range far below normal, which was 14.
“We also confirmed that the typing of the baby was totally incompatible with that of the mother, confirming the diagnosis of Rh isoimmunization, at that moment we started the transfusion, we had previously calculated how much we had to transfuse, it was around between 80 and 100 CC of this blood. and we started the procedure that lasted between 20 to 30 minutes”, he asserted.
Finally, he explained that depending on accessibility and ease, there are several techniques to reach the umbilical vein of the fetus, which is located in the umbilical cord, which has one vein and two arteries.
“We had to channel this vein as if it were a person’s arm, in this case it is obviously a cord, the umbilical vein measured 1.4 centimeters, we had to get to that point and I did it transplacentally, which is the least invasive, since that we did not have to paralyze the baby”, said Dr. Ortega de la Cruz.
Isoimmunization, erythroblastosis or perinatal hemolytic disease is a complication caused by blood incompatibility between the mother and the fetus, which can be caused by various antigens present on the membrane of fetal erythrocytes, either of the ABO group or the Rh group (1 ).
The incidence of Rh incompatibility varies by race and ethnicity, with approximately 15% of white women being Rh(-), compared to 5% to 8% of African Americans and 1% to 2% of Asians and Native Americans. (4). The most common cause of fetal anemia remains red cell alloimmunization.
Writing by Pablo Solis
