Rh-Isoimmunization, a condition where an Rh-negative mother produces antibodies that attack her Rh-positive foetus, poses significant health risks, including severe foetal anaemia. At Kingston's Victoria Jubilee Hospital, specialists have successfully performed life-saving in-utero transfusions, directly administering compatible red blood cells to the foetus. These groundbreaking procedures, crucial for preventing severe anaemia, highlight advancements in maternal and foetal medicine.

Jamaican doctors administering life-saving foetal transfusions

Jamaica Gleaner/7 Jul 2024

Erica Virtue Senior Gleaner Writer 

DESPITE ONGOING concerns over maternal and infant mortality at some hospitals, specialists across the island are employing advanced medical techniques to ensure the health and survival of vulnerable children. In recent years, Jamaica’s medical community has made significant strides in maternal and foetal medicine, particularly in the realm of lifesaving interventions for unborn children facing critical conditions.

One such area of medical advancement lies in the diagnosis and treatment of foetal anaemia, a condition often triggered by rhesus incompatibility between the mother and baby. The expectant mothers were diagnosed with a condition known as Rh-Isoimmunization, which is potentially lifethreatening for the foetus.

It occurs when the mother has an Rh-negative blood type and the baby has an Rh-positive blood type. The pregnant woman, who is Rh-negative, then produces antibodies which attack the foetus, causing it to become anaemic.

Specialists at Kingston’s Victoria Jubilee Hospital (VJH) – the premier maternal facility in the region – said they successfully conducted four in-utero transfusion since 2017, the last of which was two weeks ago. This groundbreaking procedure involves the direct transfusion of compatible red blood cells into the foetus through a needle inserted into the mother’s abdomen and into the umbilical cord that supplies the unborn child with its nutrients.

The team of OBGYN’s and maternal foetal medicine specialists, doctors Clayon Kelly, Claudia Allen-Burton and Leo-Alexi Walker successfully conducted two transfusions two weeks ago at the hospital.

Walker highlighted the importance of these interventions in preventing severe cases of foetal anaemia.

FIRST CASE

“The first case was done at VJH in 2017 with the assistance of a maternal foetal medicine specialist from overseas. The 2019 case was done by local specialists as well as the two cases two weeks ago. The babies transfused in 2017 and 2019 are both well, and the recent transfused babies will be delivered next month,” Walker told The Sunday Gleaner.

Foetal anaemia is typically detected through specialised ultrasound scans, such as Doppler ultrasounds, which monitor blood flow and detect signs of anaemia. Although symptoms may not be apparent, severe cases can lead to complications like internal swelling, necessitating vigilant monitoring and timely medical intervention.

“So what will happen is that when the baby reaches around 12 weeks, the baby’s red blood cells start to display the rhesus component. ... By around three months of the pregnancy, the rhesus-negative antigen of the baby would be attacked by the mother’s defences. Once the babies red blood cells are destroyed, they become anaemic, Walker explained.

Foetal anaemia worsens with each pregnancy, and without treatment, each successive child becomes severely affected.

Women who are Rh-negative generally get a dose of the RhoGAM injection at 28 weeks of pregnancy and again within 72 hours of labour. Walker underscored the critical role of the RhoGAM injection, administered to Rh-negative mothers carrying Rh-positive babies to prevent immune responses that could harm subsequent pregnancies. This injection, Walker said, is crucial in mitigating risks for future pregnancies and ensuring maternal health.

In addition to medical interventions, comprehensive counselling is provided to expectant mothers facing these challenges. This support aims to alleviate concerns and empower mothers with the knowledge needed to navigate their pregnancy safely.

DISCOVERING THE RISKS

Reflecting on her own experience, a mother with an O-negative blood type shared her journey of discovering the risks associated with rhesus incompatibility and advocating for the necessary preventive measures.

“I remember going to the National Blood Transfusion Centre prior to getting pregnant and that was when someone first told me that I could suffer miscarriages because I am O-negative. They broke it down for me. So, when I got pregnant, I asked the gynaecologist, and she recommended the injection,” the mother told The Sunday Gleaner.

She said awareness among mothers-to-be and healthcare providers is crucial to ensuring these preventive measures are universally understood and implemented.

“When my sister was pregnant, I had to tell her to insist that the doctor give it to her. I believe the transfusions happen because the doctors are overlooking it,” she suggested.

She also recalled her horror when, after the birth of her second child at child at VJH, “the nurse was about to give the baby the injection!”

“Is a good thing I looked at what she was doing. I had to tell her that I am supposed to get the injection,” said the mother of two healthy and happy children, a boy and girl.

Despite the success of in-utero transfusions and preventative measures like RhoGAM injections, Walker acknowledged the complexities involved in managing foetal anaemia cases. In instances where early detection or preventive measures are missed, close monitoring and timely decisions become important in safeguarding both mother and child.

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