How doctors at CHUK saved baby after mother’s five miscarriages

Doctors at University Teaching Hospital of Kigali (CHUK) have successfully performed a rare Intrauterine transfusion (IUT), allowing a severely anemic fetus to survive and be delivered healthy at 36 weeks. ALSO READ: Countries urged to ensure preterm babies have ‘best start in life’ The procedure, led by Dr. Emmanuel Nshimiyumuremyi, a Maternal Fetal Medicine Consultant at CHUK, is among the first procedures of this kind carried out in Rwanda. “The mother arrived at CHUK early in her pregnancy,” said Nshimiyumuremyi, a specialist in high-risk pregnancies. “She was carrying her sixth child, but she had only one living child. Her previous pregnancies had ended in miscarriages or stillbirths, which occurred between five and seven months.” When the mother informed the team that her blood group was B-negative, Nshimiyumuremyi ordered further tests. The results showed she had developed antibodies against the baby, a sign of Rhesus incompatibility, a condition where the immune system of a Rhesus-negative mother’s attacks the red blood cells of a Rhesus-positive fetus. “When we confirmed the presence of antibodies, we placed the mother under close surveillance, starting from the fourth month, we conducted advanced ultrasound scans every two weeks to measure blood flow in the baby’s middle cerebral artery, which shows how severe the anemia is. By 30 to 33 weeks, the anemia was getting worse.” Nshimiyumuremyi explained that at 33 weeks, the team determined that the fetus would not survive without an intrauterine transfusion. The procedure involves inserting a thin, specially designed needle through the mother’s abdomen and into the umbilical vein under continuous ultrasound guidance, to allow the fetus to receive blood directly. “If we didn’t give the baby blood, it would die,” he said. “Once the transfusion is done, the survival rate is above 95 percent.” One of the biggest challenges came before the surgery even began. Fetal transfusions require blood with an unusually high concentration of red blood cells. Adult transfusions use blood with a hematocrit of 15 to 20 percent, but fetuses in severe anemia require blood concentrated to around 70 percent, the doctor explained. “We were worried about getting the level of red blood cells,” he said, adding they had to involve the National Center for Blood Transfusion, for them to raise the level of red blood cells from 40 to 70 percent. “That was a big achievement for us,” Dr Nshimiyumuremyi noted. He added that even in other African countries where the procedure is performed more regularly, reaching such a high concentration is rare. He explained that in Ethiopia, where it is done often, they reach around 50 percent. “The procedure took between 15 and 30 minutes, depending on the baby’s position and the placenta’s location. In this case, the placenta was slightly lateral, which made the needle route more demanding.” They were a team of three: Dr Nshimiyumuremyi, Dr Fikremelekot Temesgen, a Maternal Fetal Medicine Consultant at CHUK, and Dr Heritier Gashema, a Maternal Fetal Medicine Consultant at Rwanda Military Referral and Teaching Hospital. “You cannot do this surgery alone. Someone has to assist with the instruments, to hold the ultrasound probe, and after the delivery, you need specialists ready to care for the baby,” Dr Nshimiyumuremyi said. He noted that when the transfusion stabilised the fetus, the team scheduled delivery at 36 weeks through a caesarean section, as babies who have had severe anemia cannot tolerate labour. “During contractions, the oxygen supply drops, and fetuses are not strong enough to handle that,” he said. The baby, weighing 2.5 kilograms, was handed over to neonatologists, specialists in caring for newborn babies, and hematologists, who diagnose, treat, and research blood conditions. These had been preparing for weeks to manage the newborn after birth. Nshimiyumuremyi noted that the baby is almost three months old now, healthy and anemia-free. He noted that CHUK’s ability to perform the procedure is part of a bigger effort to expand fetal medicine in Rwanda. The hospital runs a fellowship programme that will soon increase the number of specialists trained to diagnose and treat complicated conditions in the womb. He said they are already managing other serious cases, including a recent fetus with a dangerously fast heart rate that was treated in the womb and stabilised. Dr Nshimiyumuremyi noted that although Rhesus incompatibility is well documented globally, systematic screening for the condition is limited in Rwanda. “Maternal Fetal Medicine services were introduced in the country about four years ago, and currently only a few institutions, including CHUK, King Faisal Hospital, and Rwanda Military Referral and Teaching Hospital, routinely screen pregnant women. Screening is still being rolled out nationwide, so national data is not yet available,” he said. About one in 10 babies worldwide is born preterm, that is, before 37 weeks of gestation, according to the World Health Organization (WHO). The number was 13.4 million babies in 2020, says the WHO. Premature babies are at higher risk of respiratory problems, infections, and hypothermia. These complications are the leading cause of death among children under 5 years of age, responsible for approximately 900,000 deaths in 2019. At least 80 percent of these deaths occur in low- and middle-income countries. Experts note that governments, health systems, communities, and families all have a role in ensuring preterm babies receive appropriate care and support. World Prematurity Day, observed each November 17, raises awareness of how common preterm births are and the challenges they create for families and health systems worldwide.

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How doctors at CHUK saved baby after mother’s five miscarriages