During Amanda Hogan's 17th week of pregnancy, the 31-year-old mother of two girls faced a crisis. She had developed a condition in which her own Rh-negative blood was producing antibodies that were attacking the Rh-positive red blood cells of the child she was carrying.
Amanda's obstetrician in her hometown, Sioux City, Iowa, had been carefully monitoring the baby's condition, and Amanda had also consulted Michael Barsoom, MD, director of maternal-fetal medicine at Creighton University Medical Center in Omaha, Nebraska, 90 minutes away. So far, doctors had found no evidence that the antibody levels were causing harm.
Suddenly, however, an ultrasound test revealed problems in the flow of blood through the baby's brain, indicating that she was anemic. Amanda's doctors were very concerned.
"I've never been so terrified in my life," Amanda says. "Every day, I'd wake up and wonder, Is this the day I lose my baby?"
Each year in the United States, thousands of pregnancies involve mothers and babies with similarly incompatible blood types, but Rh disease has been largely preventable since 1968, thanks to a shot for the mother that greatly reduces her risk of forming antibodies. According to Dr. Barsoom, the injection treatment can lower the chance of a mother's developing the problem to less than 1 percent.
Amanda did have the shot during a previous pregnancy. Why it did not work for her this time is unknown.
Dr. Barsoom told Amanda and her husband, Keith, 35, that there was only one way to save the baby: a fetal blood transfusion. Under ordinary circumstances, the procedure involves inserting a long, thin needle into the baby's umbilical cord and giving her Rh-negative blood, which her mother's antibodies won't destroy.
The treatment is usually done after the 20th week of pregnancy, when the blood vessels in the cord have grown large enough to accommodate the transfusion needle. If a baby needs the transfusion before that stage, a doctor can inject the blood into its abdomen.
In Emma's case Dr. Barsoom advised moving ahead immediately with the treatment. "Given the fetus's anemia, there was no other choice but to do it at that time," he recalls.
"I felt I'd aged 20 years during those weeks," says Amanda, who was devastated to know that her baby, whom she and Keith had already named Emma, was in increasing jeopardy. The couple decided to take a chance on a transfusion.
In severe cases like Emma's, the child typically receives transfusions every two to three weeks. By the 30th week of the pregnancy, Emma had required six, each of which imposed on Amanda a small chance of miscarriage or preterm delivery.
"I felt so helpless," says Amanda. "All I could do was pray she would be okay."