If your doctor has recommended an intrauterine transfusion (IUT) to treat your infant due to anemia or a rare disease like fetal and neonatal alloimmune thrombocytopenia (FNAIT), you may be wondering if your infant will be sedated.
Understanding what this lifesaving procedure involves and how sedation is used to enhance safety and comfort may help reduce worries, should it become necessary.
What is an intrauterine transfusion?
An IUT is a delicate procedure in which blood products are given directly to the fetus before birth. In FNAIT, this often means giving specially matched donor platelets to raise the baby’s platelet count and reduce the chance of bleeding.
Using continuous ultrasound guidance, a maternal–fetal medicine specialist carefully inserts a thin needle through the mother’s abdomen into a blood vessel in the umbilical cord, or occasionally into the baby’s abdomen. Platelets (or red blood cells if the baby is anemic) are then slowly infused into the baby’s circulation so the team can carefully monitor the fetus’s response. Because this needle must remain precisely in place, the mother and fetus are gently sedated to minimize the risk of injury.
Read more about FNAIT treatment and care
The role of sedation: Keeping mother and baby still
To ensure the procedure is as safe as possible, both mother and baby will receive medications to remain calm, relaxed and free of pain. The medical team should be informed of any potential drug allergies so that appropriate precautions can be taken.
Typically, the mother receives medication through an IV to lessen anxiety and discomfort, often with a low dose of a sedative like midazolam or a pain reliever such as fentanyl. Some of these medications cross the placenta, offering mild sedation to the fetus as well.
In most cases, the doctor will also numb a small area on the mother’s abdomen and uterine wall with a local anesthetic such as bupivacaine. This approach lessens the sensation of the needle to that of a dull pressure, not sharp pain.
Once the needle is in place, the baby can receive medications to prevent any pain or movement. A neuromuscular blocking agent, such as vecuronium or pancuronium, will be given to briefly stop muscle movement and prevent reflex kicks or sudden motions while the transfusion is taking place. These “paralyzing” medications work only at the level of the muscles and do not cause unconsciousness or pain relief on their own, which is why an opioid such as fentanyl is an essential part of the combination.
All of these medications are carefully calculated based on the estimated fetal weight so that they last only as long as needed for the transfusion.
Safety and reassurance for parents
It is completely natural to feel nervous about giving medications to an unborn baby. However, it is also important to remember that sedation is vital for reducing complication risks by preventing needle slips or umbilical cord injuries if an IUT is necessary.
The medications used have been studied in many people undergoing procedures like IUTs and specialized fetal therapy. Their effects are temporary; once the transfusion is finished, the medications wear off and normal movement resumes. Never forget that throughout and after the IUT, the medical team carefully monitors the mother and baby with ultrasound and vital sign checks.
The bottom line
Fetal sedation during intrauterine transfusions (IUT) is a vital part of care for some pregnancies with FNAIT. It helps keep the baby still, allowing specialists to perform precise, lifesaving platelet transfusions. The small, closely monitored doses wear off within hours and should have no lasting effect on your child.
If your doctors recommend an IUT with fetal sedation, they believe it offers your baby the best chance at a healthy outcome. You can always ask your maternal–fetal medicine team to explain each step, the medications used and how they will care for you and your baby before, during and after the procedure.
