An Rh-sensitised woman at 26 weeks has a fetus with MCA-PSV above 1.5 MoM confirming severe anaemia. Intrauterine transfusion is planned. Via which route is the transfusion currently administered as first choice?

• A Intravascular transfusion into the umbilical vein under ultrasound guidance ✓
• B Intraperitoneal transfusion into the fetal peritoneal cavity
• C Direct intracardiac injection into the left ventricle
• D Intravenous transfusion through the fetal portal vein

Explanation

Intravascular intrauterine transfusion via cordocentesis into the umbilical vein, ideally at its placental insertion or intrahepatic course, is the current first-line approach because it allows immediate correction of anaemia and accurate pre and post-transfusion haematocrit measurement. Intraperitoneal transfusion is reserved for situations where vascular access is impossible, such as very early gestation, since absorption across peritoneum is slow. Cardiac injection risks tamponade and arrhythmia, making it unacceptable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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