A sensitized Rh-negative woman at 30 weeks has an MCA-PSV of 1.65 MoM with early hydropic changes on ultrasound. Intrauterine transfusion is planned. Which route is the current method of choice for fetal transfusion at this gestation?

• A Intraperitoneal transfusion via a trocar into the fetal peritoneal cavity
• B Intravascular transfusion into the umbilical vein under ultrasound guidance ✓
• C Intracardiac transfusion into the left ventricle
• D Exchange transfusion via cordocentesis with immediate delivery

Explanation

Ultrasound-guided intravascular transfusion into the umbilical vein, usually at the cord insertion into the placenta, is the standard technique because it allows direct measurement of fetal haematocrit, precise targeting of the target haematocrit, and better survival than older methods. Intraperitoneal transfusion is reserved for very early gestations where cord access is technically impossible, relying on lymphatic absorption. Intracardiac access carries unacceptable arrhythmia risk, and exchange transfusion is a neonatal procedure performed after delivery, not a fetal therapy.

Reference: Rodeck and Whittle: Fetal Medicine, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.