Wed | Aug 15, 2018

Historic surgery! - Doctors perform first-ever blood transfusion operation on an unborn child at VJH

Published:Sunday | July 23, 2017 | 12:00 AMErica Virtue
The medical team which performed a groundbreaking surgery at the Victoria Jubillee Hospital last Thursday. Front row (from left): Dr Clayon Kelly, consultant, maternal foetal medicine; Dr Bettina Paek, maternal foetal medicine specialist; Dr Noreen Stephens, resident anaesthesiologist. Back row (from left): Dr Hayden Hamil, resident OB-GYN; Dr Leroy Campbell, consultant, maternal foetal medicine; Dr Ethan Dixon, resident OB-GYN.
Dr Orville Morgan

At six months, the tiny foetus does not have a voice, but if it did, it would probably be screaming thank you to medical personnel at the Victoria Jubilee Hospital (VJH).

Last Thursday, specialists at the maternal hospital pulled off a possibly lifesaving blood transfusion operation on a foetus which was being harmed by its mother's body.

"The transfusion was done with the needle placed in the blood vessel of the foetus without puncturing the amniotic sac.

"It was done under ultrasound guidance and inside the operating theatre in case anything went wrong and we had to convert to delivery," senior medical officer and consultant in obstetrics and gynaecology at the VJH, Dr Orville Morgan, told The Sunday Gleaner.

He said while the condition is not uncommon, it was the first time the operation was being done locally.

The carefully coordinated operation saw negative cells transfused into the baby so the mother's body could stop fighting the unborn child.

"Enough negative blood was given to the foetus so it can survive long enough to get out of its mother's way. What we have done is to make sure the mom's body does not recognise it as an enemy and destroy it," said Morgan.

The potentially lifesaving operation had to be done in collaboration with the National Blood Transfusion Centre (Blood Bank), and Morgan noted that blood of the right concentration and consistency had to be given to the foetus.

He said the foetus would not reject the blood as its immune system is not that advanced, but the team was careful in giving the blood.

Morgan noted that the medical team will not know until a few weeks if all is well as the foetus will take time to adjust to the blood.

"If all goes well, the pregnancy can be prolonged for another six weeks so the baby can be delivered," said Morgan.

The senior medical team at the VJH was called in after the expectant mother was diagnosed with a condition known as Rh-Isoimmunization.

This occurs when a woman with Rh-negative blood type is exposed to Rh-positive blood cells, leading to the development of Rh-antibodies.

The pregnant woman, who is Rh-negative, then produces antibodies which attack the foetus, causing it to become anaemic as the baby's blood, which is Rh-positive, is offensive to the mother, who ends up fighting her own child.




With the aid of a visiting expert from the United States, the medical team at the VJH opted to perform the ground-breaking surgery.

"It's not her fist child. The previous child suffered badly. And the main cause of this is because of incompatibility between her blood group and her spouse's blood group.

"When this happens, the mom forms what is called antibodies - substances that are formed to fight off infections - against the baby's blood group. Those antibodies cross the placenta and go into the baby's blood and start to break down the baby's blood, and the baby becomes severely anaemic," explained Morgan.

He noted that the condition worsens with each pregnancy, and without treatment, each child becomes severely affected.

"This type of severe anaemia can cause the baby to die. The baby began to develop a condition called hydropsfetalis with fluid gathering in a number of cavities. The baby was getting really sick," added Morgan.

He noted that in such situations, the risk factor is primarily the foetus and there are no symptoms shown by the mother.

The mother's condition became a case study for senior doctors where treatment strategies were devised, and Morgan noted that it is of critical importance that pregnant women visit clinics so that blood tests can be done to determine their blood group and see if the rhesus factor is negative or positive.

He says the hospital sees three to four cases per month and the disease is generally preventable.

"When the baby is born we can treat with an exchange transfusion, but if the pregnancy is not advanced for us to safely take out the baby, then we have to do something else," said Morgan, as he reiterated the importance of blood tests being done by all pregnant women to eradicate threats such as HIV, syphilis and sickle cell anaemia.