Infants who receive their last intrauterine transfusion (IUT) for hemolytic disease of the fetus and newborn (HDFN) after 34 weeks of gestation may be less likely to require an exchange transfusion after birth, according to a study abstract published in Ultrasound in Obstetrics & Gynecology.
IUTs are used to deliver blood to the fetus during pregnancy, and exchange transfusions (which can be given during or after pregnancy) remove the baby’s blood and replace it with donor blood. Some infants with HDFN require both procedures to manage their symptoms.
In their study, the authors sought to determine whether the timing of IUTs can impact neonatal outcomes and limit exchange transfusion requirements after birth.
The study focused on 73 infants who received IUTs between January 2008 and February 2025 and had a live birth at a medical center in South India. In all cases, fetal anemia was caused by Rh incompatibility. Participants received a total of 183 IUTs during the study period.
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Results showed that of the 50 infants whose last IUT occurred before 34 weeks, 38 (76%) also received an exchange transfusion. Additionally, 36 of the 50 infants (72%) were born prematurely. The authors recorded 3 deaths due to prematurity in infants delivered between 31 and 34 weeks of gestation.
Of the 23 patients who had their final IUT after 34 weeks, only 43.5% received an exchange transfusion. Furthermore, all participants, regardless of whether they received an exchange transfusion, had positive outcomes. In this group, 52.2% of infants were born prematurely, the majority of whom were born between 36 and 37 weeks. No neonatal deaths were recorded.
“We recommend delivery after 37 weeks for fetuses with anemia that have undergone IUTs, particularly if uncomplicated and in experienced hands,” the authors concluded. “This approach can reduce [neonatal intensive care unit] costs and long-term morbidity linked to preterm delivery in fetuses with anemia.”
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