Extending delivery at or beyond 34 weeks and performing the last intrauterine transfusion (IUT) around that time could be beneficial in pregnancies complicated with hemolytic disease of the fetus and newborn (HDFN), according to a recently published study in Frontiers in Medicine.
IUT has become the standard of care for fetal anemia due to HDFN and other causes. Despite its efficacy, the procedure carries risks such as preterm labor, infection and fetal death, though these are rare.
Historically, the last IUT is recommended between 30 and 32 weeks of gestation, with delivery planned around 34 weeks to minimize procedural risks. However, emerging evidence points toward the benefits of extending pregnancy closer to term. Recent advances in procedural safety and fetal monitoring have prompted a reevaluation of earlier guidelines, suggesting that term delivery may offer long-term benefits.
The authors aimed to assess whether performing the final IUT at or beyond 34 weeks could improve maternal and neonatal outcomes without compromising safety.
The study analyzed 200 IUTs across 52 pregnancies between 2005 and 2024. Patients were categorized into two groups: those receiving their last IUT before 34 weeks and those receiving it at or after 34 weeks .
Pregnancies in the late ITU group were carefully selected based on fetal stability, absence of hydrops (liquid accumulation in fetal tissues), and a history of uncomplicated procedures.
The late IUT group showed no procedure-related complications compared to a 20% rate in the early IUT group . Additionally, this group had significantly improved outcomes including higher gestational age at delivery , lower emergency cesarean rates , and reduced neonatal intensive care unit (NICU) admissions . Newborns in the late IUT group also had higher birth weights and better hematocrit levels at birth. These results remained robust even after adjusting for maternal factors and prior obstetric history.
“This evidence-based approach aligns with the broader trend in maternal-fetal medicine toward optimizing gestational age at delivery, suggesting that an individualized strategy extending IUT to 36 + 6 weeks can help achieve the well-documented benefits of term delivery in this high-risk population,” the authors concluded.
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