Intrauterine rescue transfusion in monochorionic multiple pregnancies withrecent single intrauterine death

To assess the role of fetal blood sampling and intrauterine transfusion in monochorionic (MC) multiple pregnancy complicated by single intrauterine de ath (IUD). we reviewed ten cases over a 4-year period in a tertiary referra l centre which underwent fetal blood sampling within 24 h of death of its M C co-twin. Intrauterine rescue transfusion was performed in all seven anaem ic fetuses (hematocrit; Hct < 30%) to raise the fetal Hct to greater than o r equal to 40%. The rationale was to prevent death and/or brain injury. Two fetuses. which were severely acidaemic at blood sampling, died in utero wi thin 24 h of the procedure. In two cases, the surviving twins manifested ab normal sonographic findings of the fetal brain 2-5 weeks later and underwen t late termination. In two cases, the pregnancies continued uneventfully un til delivery at 35 and 40 weeks' gestation with good neonatal outcome. In o ne case the co-twin delivered 1 week later at 29 weeks but died within 12 h . Fetuses without anaemia were not transfused and had normal clinical outco mes. We suggest that intrauterine rescue transfusion before the development of severe acidaemia in anaemic surviving MC co-twins may prevent fetal dea th, but does not necessarily prevent brain injury. Until its role becomes c learer, we recommend that its use be restricted to situations in which the parents and the local jurisdiction allow late termination as an option if b rain injury subsequently manifests on ultrasound. Copyright (C) 2001 John W iley & Sons. Ltd.