It is a process of administering blood transfusion to the fetus in utero.

Indications are :

	Severe fetal anaemia before 32 weeks
	Rh isoimmunisation
	Fetal infections like parvo virus infection
	Haematological disorders etc.

Aim of the transfusion is to continue pregnancy for couple of weeks more ; so that the baby will be sufficiently mature to survive outside the uterus.

It is undertaken by puncturing umbilical vein, usually at placental cord insertion with 20 – 22 guage needle under ultrasound guidance. Intraperitoneal instillation can also be done. Transfusions are repeated depending upon the haematocrit drop. Fetal transfusion can be started at 20 weeks and repeated till 30 – 34 weeks. O negative packed cells are used for transfusion.

Amnio infusion

Procedure where warm (body temperature) normal saline is infused into the amniotic sac under ultrasound guidance.

Therapeutic :

1. In severe Oligohydramnios in order to avoid complications like cord compression, and fetal distress.
2. In order to dilute meconeum in meconeum stained liquor.

Diagnostic :

For better imaging with ultrasound for detection of fetal congenital anomalies.

Amnio reduction

Removing the aminotic fluid under ultrasound guidance in order to relieve maternal discomfort due to pressure effects in polyhydramnios. To reduce the complication in twin to twin transfusion syndrome.

Amniopatch

This is a procedure useful in cases where there is pre-term premature rupture of membranes due to a small rent in amniotic membrane. This is most useful in leaking after intrauterine procedure and spontaneous high leak in membrane. The procedure involves injecting platelist concentrate and cryoprecipitate into the amniotic cavity, where-by the rent in the amniotic membrane is sealed by a fibrin clot.

These are the intrauterine procedures that are currently undertaken at our centre. More procedures like intrauterine bladder stenting may be available in future.