Bronchopleural fistula following intrauterine transfusion.

An infant developed a bronchopleural fistula following intrauterine transfusion given for severe haemolytic disease of the newborn. The fistula was shown to be due to the transfusion being given into the right pleural cavity and lung. Initial treatment along conservative lines is suggested, reserving thoracotomy and lobectomy for use if these simple measures fail. Hypocalcaemia was a complicating feature. The technique of intrauterine transfusion of the fetus in severe rhesus isoimmunization has enabled many infants to survive who would otherwise have died (Liley, 1963; Fairweather et al., 1967). Survival rates have so improved that 30 to 50% are now liveborn who would otherwise have died in utero. There are endless possibilities of injury to the fetus during the procedure yet surprisingly few have been reported. This case is presented because of the previously unrecorded complication of bronchopleural fistula. CASE HISTORY This male infant was born to a healthy 41-year-old mother in her fifth pregnancy. One previous child had required exchange transfusion for erythroblastosis fetalis. The father was heterozygous rhesus positive (CDe/cde). The maternal antibody titre was positive at 1 in 256 dilution at 22 weeks' gestation. Amnio-centesis at 26 weeks' gestation gives a high zone result (Liley, 1963). The first intrauterine transfusion was carried out at 26 weeks' gestation. Several attempts were required before the fetal peritoneal cavity was punctured and 60 ml of warmed packed blood infused. Spontaneous vaginal bleeding occurred the following day and lasted a few hours. Ten days after the first intrauterine transfusion spontaneous rupture of the membranes occurred and liquor continued to drain thereafter. A second intra-uterine transfusion was given during the twenty-eighth week, only one attempt at fetal puncture being required. Labour began spontaneously in the thirtieth week following a small antepartum haemorrhage. A male infant weighing 1,400 g was delivered by the breech. The liver and spleen were both palpable 3 cm below the costal margin. The placenta weighed 350 g and was oedematous. The Apgar score was 1 at 1 minute, rising to 6 at 10 minutes with the help of intermittent positive pressure ventilation and intravenous sodium bicarbonate and dextrose. Cord blood results were: Coombs test positive, haemoglobin 11 9 g/100 ml, serum bilirubin 4 mg/ 100 ml. Small repeated exchange transfusions were given during the first day after birth, intravenous infusion of 10°' dextrose being maintained in the intervening periods. The infant had moderately severe respiratory distress syndrome. Ten hours …