IUT #2 28/8/2009

Things certainly didn't go as smoothly as the first IUT. To start off little miss was laying right against the placenta and the cord making it quite difficult to get a needle in. Dr had to make 2 attempts, the first just missed and was sitting in the fluid rather than in the vein. Second attempt it worked perfectly

Unfortunately for me i could feel everything! The fab cocktail of drugs from 2 weeks earlier did not work at all this time. Some people say it is like an amnio, i disagree! Much more painful than an amnio and the IUT took over 40 minutes to be complete...with tightenings etc

First lot of her blood drawn cam back with a Hb of 70 (previous Hb prior to the IUT was 79) and a hematocrit of 21.

Working out all the math they came to the conclusion she could have 130ml of blood but my Dr didn't think they would get that much in.

They managed to get 100ml in before her cord pressures started going up at which point he stopped. Whilst waiting for the final blood results from the lab he decided enough was enough and stopped. Thankfully the blood that she got was good and done the job even though it was less. Her final Hb was 159 and her final Hematocrit was 46

I had managed to work up a bit of a sweat during it all, it was such a weird sort of pain...one midwife run off to find some cold compresses for me and help cool me down and the other Dr was worried and kept checking my pulse. I know at one point my BP got up to 158 or something....i am generally a 110-120 girl. I didn't catch the second number

There were 2 Chinese Dr's observing and lucky old me got to have my photo taken during it all LOL At least only people in china are going to see it

Up in birthing unit it took miss just over 4 hours to wake up this time. My Dr kept popping and and made sure the CTG was to stay on all night long....14 long long hours on it to be exact! But everyone was happy this morning so that is the main thing.

Down for a scan to check the site and check her dopplers. Everything looked good. He said he hopes we can get 3 weeks but i am to go back in just under 2 to check everything. He also wants to give me phenobarbital to help develop her liver enzymes. It helps them to break down the jaundice more efficiently once they are born rather than waiting for their liver to mature. He is chasing up the bili levels because he got 2 number...1 that seemed right - only gone up a bit and another that was sky high...so he is trying to find out what the result is and will chase up NICU about giving the phenobarbital based on the results...seems like they have to say yes as well

Oh and my blood weren't a typo my d-quant (which is the more accurate reading) was 230!!! I seriously didn't know it could go so high - mine got to 18 when Ethan was born but now it is going hyper!

Back on the 7th when my Dr will be away LOL Lets see if we have a baby that week! Or i have to go back as soon as i notice a change in her movements

IUT #1 11 August 2009

Finally out of my drug induced haze!

Yesterdays transfusion itself went really well. She was definitely anaemic and needed it. Dr was very pleased he was able to get a line into the umbilical cord rather than into a vessel that she wont use after she is born.

Night on the CTG...omg that was tough! A)I am not a back sleeper and of course you have to stay on your back to get good contact on a little person. B) it was birthing unit Some of those women are LOUD...one went on for over 2 hours!!! and C) Missy wanted to play catch me if you can so of course it alarmed all night long and i got probably 1 hours sleep!

Had my follow up scan this morning - basically give my Dr a baseline for post transfusion dopplers (even though they arent reliable) and to check the site where he put the needle in. Everything looked fine. No worries about prom because he didnt even need to go into the sac...right through the placenta in the the cord.

Sadly it looks like we will be back for another in a week or 2 - most probably a week. My antibodies them selves have taken off like a wildfire and that was before he stuck the big old needle right through the placenta. So in thinking i will be 30 weeks next week and he probably wouldn't even transfuse after 32 weeks we have roughly 2 weeks to go - if things carry on as he expects!

So it was a bit of a mixed bag but the transfusion went well and she is still baking away.

FWIW, on Monday her estimated weight was 1475g

This pic was meant to show the excellent trace after the IUT...think i need to figure out the camera on the laptop ;-)



And a lovely (not) fat pregnant and tired pic (well i guess i could say under the influence of drugs too)

What is an intrauterine transfusion

It is as scary as it may sound. Basically it is an unborn baby having a blood transfusion prior to birth. This is done only when needed, a baby must show signs of severe anaemia before an IUT will be performed as there are many risks and even though the benefits far outweigh the risks no one wants to risk the health of a baby who isn't ill.

The follow are the answers to some of the questions i have been asked since having my IUT, hopefully these answers will help some people understand a little bit better and also give some insight to anyone who may be facing an IUT.

Is it like an amnio?
For me the only thing similar to it being like an amnio is that there was a big old needle going through my pregnant tummy. Unlike an amnio the needle did not go into the amniotic fluid, instead it went through the placenta into the umbilical cord.

Did it hurt
The first one did not hurt, i was given a cocktail of drugs to sedate me prior to the procedure. I was given a combination of pethidine, temazepan, phenergan and something else i cant remember the name of. I was also given a drug to prevent uterine contractions and prior to the big needle going in i was given a local anaesthetic into my tummy as well. The first IUT i was blissfully unaware of it all, i basically closed my eyes and relaxed.

The second one was a different story. I had the exact same drugs and i felt every little bit of the procedure. My Dr said that it was probably due to anxiety that they didnt work. But yes in that instance it was very painful. My blood pressure shot up and i was covered in sweat.

Did the baby move?
No, once they positioned the needle and drew out some of her blood to test her Hb and a few other things Riley was given a sedative called pancuronium. This generally keeps the baby asleep for around 3-4 hours. That is a very scary time because you do not feel anything, the usual reassuring kicks are no longer there and all you can do is watch the CTG machine to know that all is ok in there.


Now to put it all together. You are sedated and the needle is guided into position via ultrasound, the ultrasound continues for the entire procedure. A small amount of fetal blood is taken to check the fetal Hb etc. The pathology lab is on standby for the bloods as the results need to be relayed back ASAP. At this stage the baby is given its sedative. Blood is slowly transfused into the baby, all the time both the Dr and his assistant are watching to make sure the blood is going into the right place. Apparently you can see little bubbles as it goes in, i chose not to look at the u/s screen. The babys heart rate is constantly monitored for any significant changes and the pressure in the cord is also monitored. If at any stage the baby shows signs that he/she isnt happy the procedure is stopped and if need baby the baby will be delivered by emergency c/s. Although most babys do pick back up if the amount of blood transfused at a time is reduced or the needle is removed. Riley at one stage during the second IUT was not happy so the transfusion was slowed down and the amount each time was reduced.

At the end of the procedure, they take another small amount of blood from the baby to make sure that the RBC have gone to the right place and so they have a final Hb and crit level for the baby. All going well, these should now be back into a more normal range. The new levels can also help the Dr's predict when they may need to repeat the procedure.

According to the text books, an IUT is meant to last for anywhere between 2-4 weeks depending on how aggressive the antibodies are. My antibodies were very aggressive, giving us just 2 weeks exactly between transfusions.

I think i may have covered everything, i hope i have but please feel free to post if you have any further questions and if i think of anything else to add i will be sure to update this post

August 3 2009 - 28 weeks

Well where do i start

Had yet another scan today - we got some very high readings and some high but not over the transfuse line readings. At first my Dr thought that we would be doing a transfusion but with the second lot of numbers all being consistent we are going back on Wednesday for another scan and another CTG. I am having CTG's with every scan now.

He said it is no longer a case of if we will do a transfusion but more of a when will we do it. He doesn't want to go in and find out she isn't as anaemic as we think.

My placenta basically is covering the front of my uterus, making it hard to do anything. He would do an amnio but doesn't want to go through the placenta because that can set everything off and make the antibodies go crazy - Wednesday might be a different story as he said he may try it with me laying right over on my side.

He was tossing up weather to give me steroids today but doesn't want to because for a week after them my dopplers are no use to him because they make them unreliable. So steroids will be done when they really really have to be.

So if we do go down that path, i will be in hospital at least overnight. They do some serious monitoring and if at any time during the transfusion or after it if she isn't looking too happy they will deliver her - now that really scares me!