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Intravenous Pancuronium Bromide for Fetal Neuromuscular Blockade During Intrauterine Transfusion for Red-Cell Alloimmunization

From the Prenatal Diagnostic Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

Abstract

Intravenous pancuronium bromide was administered into the umbilical cord by funipuncture to effect temporary fetal paralysis. Neuromuscular blockade was achieved in 12 fetuses undergoing a total of 34 intrauterine procedures for the treatment of severe red-cell alloimmunization. The same initial dose of 0.2 mg/kg fetal weight estimated by ultrasound was used in all cases, but anemic fetuses did not resume movement for prolonged periods. A relationship among fetal hematocrit, adjusted dose, and duration of paralysis was described by the equation: Duration (hours) =5.24 + 0.30 adjusted dose (mg/kg) – 0.16 hematocrit (%) (R² =0.49; P < .001). Intravenous pancuronium was found to be a safe and effective method for cessation of fetal movement during intrauterine procedures.