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Intrauterine transfusion: Best practices, techniques, and evolving trends.

Roland Devlieger1, Simen Vergote1, Emma Van den Eede2

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PubMed
Summary

Intrauterine transfusion (IUT) is a vital treatment for severe fetal anemia. Advances in ultrasound-guided techniques have improved survival rates, though challenges remain for early and recurrent interventions.

Keywords:
Fetal anemiaFetal hydropsFetal therapyHemolytic disease of the fetus and newbornIntrauterine transfusionRed-cell alloimmunization

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Area of Science:

  • Perinatology
  • Maternal-Fetal Medicine
  • Pediatric Hematology

Background:

  • Severe fetal anemia necessitates intervention, with red blood cell alloimmunization being a primary cause.
  • Intrauterine transfusion (IUT) is the established treatment, now also used for non-immune conditions like twin complications and parvovirus B19.
  • Recent advancements focus on improving IUT safety and efficacy.

Purpose of the Study:

  • To provide a comprehensive review of current best practices and recent developments in intrauterine transfusion (IUT) therapy.
  • To cover indications, diagnostic strategies, procedural techniques, outcomes, and emerging trends in IUT.
  • To synthesize evidence from guidelines, cohort studies, and expert consensus.

Main Methods:

  • Narrative review of evidence-based guidelines, multicenter cohort studies, and expert consensus statements.
  • Focus on diagnosis and management of fetal anemia, procedural safety, timing, and transfusion strategy.
  • Analysis of center-level practices and outcomes.

Main Results:

  • Ultrasound-guided intravascular transfusion (via intrahepatic vein or placental cord) has significantly reduced procedure-related risks.
  • Survival rates for IUT now exceed 85% in most settings, with favorable long-term outcomes.
  • Challenges persist in early gestational interventions and managing recurrent transfusions.

Conclusions:

  • Intrauterine transfusion (IUT) is a highly effective intervention for fetal anemia.
  • Specialized centers with multidisciplinary expertise are crucial for optimal IUT outcomes.
  • Ongoing research addresses challenges in early and recurrent IUT procedures.