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Maternal Isoimmunization-Associated Fetal Anemia After First-Trimester Abortion: A Case Report and Literature Review
Fatemeh Golshahi1, Behrokh Sahebdel2, Fatemeh Rahimi-Sharbaf3
1Department of Obstetrics and Gynecology, Fellowship of Maternal Fetal Medicine Yas Hospital Complex, Tehran University of Medical Sciences Tehran Iran.
Clinical Case Reports
|April 13, 2026
Summary
Rh isoimmunization and fetal anemia present significant obstetric challenges. This case series highlights successful management of two pregnancies with Rh isoimmunization using intrauterine transfusions, leading to healthy neonates and suggesting early Rh immunoglobulin administration post-abortion.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Neonatology
Background:
- Rh isoimmunization and fetal anemia are critical obstetric concerns, potentially leading to hydrops fetalis, fetal anemia, and fetal loss.
- Management requires vigilant monitoring and timely interventions like intrauterine transfusion (IUT) and postpartum care.
- Uncertainty exists regarding Rh immunoglobulin (RhIg) administration in early pregnancy (before 12 weeks) for RhD-negative mothers.
Purpose of the Study:
- To examine the clinical course, management strategies, and neonatal outcomes in two pregnancies complicated by fetal anemia and Rh isoimmunization.
- To emphasize the importance of Rh immunoglobulin (RhIg) administration in early pregnancy, particularly after abortions, to prevent isoimmunization.
Main Methods:
- A case series presentation of two RhD-negative pregnant women with histories of early pregnancy loss and fetal anemia due to Rh isoimmunization.
- Detailed description of interventions, including intrauterine transfusions (IUTs), and monitoring of fetal hemoglobin levels and antibody titers.
- Review of neonatal outcomes, including Apgar scores, bilirubin levels, hemoglobin levels, and long-term development.
Main Results:
- Both patients underwent multiple IUTs with successful delivery of healthy neonates at term.
- The first patient received two IUTs; the neonate had elevated anti-D and anti-C titers.
- The second patient required four IUTs; the neonate had normal Apgar scores, hemoglobin, and long-term development.
Conclusions:
- Intrauterine transfusion is an effective management strategy for severe fetal anemia due to Rh isoimmunization.
- Effective management of early abortions (before 12 weeks) in RhD-negative women carrying RhD-positive fetuses is crucial for preventing isoimmunization.
- Administration of Rh immunoglobulin (RhIg) following early abortions is recommended to prevent future adverse outcomes.
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