ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1614989
This article is part of the Research Topic25 Years of 21st Century MedicineView all 17 articles
Late vs. Early Intrauterine Blood Transfusion in Fetal Anemia: Impact on Maternal and Neonatal Outcomes
Provisionally accepted
Adva Cahen Peretz1,2*
Lilah Tsaitlin-Mor1,2Gideon Leibner1,2
Sarah M Cohen1Danielle Amosi-Victor1,2
Nitsan Haham2
Tomer Shwartz1,2Nili Yanai1,2
Shay Porat1,2
Simcha Yagel1,2*Dan Vadim Valsky1,2- 1Hadassah Medical Center, Jerusalem, Israel
- 2Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Jerusalem, Israel
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Intruduction: Optimal timing of final intrauterine transfusion (IUT) and delivery in fetal anemia remains controversial, balancing procedural risks against prematurity complications. Our objective is to evaluate the safety and effectiveness of extending IUT beyond 34 weeks gestation in appropriately selected cases.Methods: Retrospective cohort study comparing pregnancies receiving late IUT (≥34 weeks, n=21) versus early IUT (<34 weeks, n=31) at a single tertiary center (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023)(2024). We analyzed 200 IUT procedures in 52 pregnancies. Late IUT was offered to stable cases without hydrops or previous significant complications. Primary outcomes included procedure-related complications and prematurity-related outcomes.Results: Late IUT showed no increase in procedure-related complications (0% vs 20.0%, p=0.069). Mean gestational age at delivery was higher in the late IUT group (37.2±1.06 vs 34.1±3.6 weeks, p<0.001), with reduced emergency cesarean rates (19% vs 45%), higher birth weights (2960±399g vs 2350±620g, p<0.001), and lower NICU admission rates (29% vs 71%, p<0.05). These benefits persisted after adjusting for maternal characteristics. Subgroup analysis of hemolytic disease cases showed similar improvements with additional benefits in neonatal outcomes.Discussion: Extending IUT beyond 34 weeks in selected cases is safe and associated with improved obstetric and neonatal outcomes, supporting reconsideration of traditional gestational age limits for IUT.
Keywords: Intrauterine Blood Transfusion (IUT), Fetal anemia, Hemolytic disease of the fetus and newborn (HDFN), Late Gestation IUT, Neonatal morbidity, Prematurity complications, Alloimmunization
Received: 20 Apr 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 Cahen Peretz, Tsaitlin-Mor, Leibner, Cohen, Amosi-Victor, Haham, Shwartz, Yanai, Porat, Yagel and Valsky. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Adva Cahen Peretz, Hadassah Medical Center, Jerusalem, Israel
Simcha Yagel, Hadassah Medical Center, Jerusalem, Israel
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