Intrauterine transfusion: Best practices, techniques, and evolving trends

Abstract

Intrauterine transfusion (IUT) remains the cornerstone of treatment for severe fetal anemia, particularly due to red blood cell alloimmunization, and is increasingly utilized in select non-immune conditions such as complicated monochorionic twins and parvovirus B19 infection. This narrative review provides a comprehensive overview of current best practices and recent developments in IUT therapy, including indications, diagnostic strategies, procedural techniques, outcomes, and emerging trends. Evidence-based guidelines, multicenter cohort studies, and expert consensus statements were reviewed, with particular attention to diagnosis and management of fetal anemia, procedural safety, timing, transfusion strategy, and center-level practices. The introduction of ultrasound-guided intravascular transfusion via the intrahepatic vein or placental cord insertion has markedly reduced procedure-related risks, resulting in survival rates exceeding 85 % in most settings and favorable long-term outcomes. Despite these advances, challenges persist for early gestational interventions and recurrent transfusions. Overall, IUT is a highly effective intervention for fetal anemia when performed in specialized centers with multidisciplinary expertise.

Keywords: Fetal anemia; Fetal hydrops; Fetal therapy; Hemolytic disease of the fetus and newborn; Intrauterine transfusion; Red-cell alloimmunization.