Fetal Anemia: Determinants and Perinatal Outcomes according to the Method of Intrauterine Blood Transfusion

<b><i>Introduction:</i></b> Fetal anemia from hemolytic disease treated by intrauterine transfusion (IUT) can be performed by intraperitoneal, intracardiac, and intravascular transfusion (IVT). Objective of our study was to compare different transfusion techniques. <b><i>Methods:</i></b> Retrospective review of IUT secondary to red cell alloimmunization was conducted at eight international centers from 2012 to 2020. Severe anemia suspected if middle cerebral artery peaks systolic velocity ≥1.5 multiples of the median. Demographic, delivery, and postnatal variables were analyzed. <b><i>Results:</i></b> Total of 344 procedures, 325 IVT and 19 other techniques (non-IVT) included. No difference in demographics, history of stillbirth (20.5 vs. 15.8%, <i>p</i> = 0.7), prior pregnancy IUT (25.6 vs. 31.6%, <i>p</i> = 0.5) or neonatal transfusion (36.1 vs. 43.8%, <i>p</i> = 0.5). At first IUT, non-IVT had higher hydrops (42.1% vs. 20.4%, <i>p</i> = 0.03), lower starting hematocrit (13.3% [±6] vs. 17.7% [±8.2], <i>p</i> = 0.04), and trend toward lower gestational age (24.6 [20.1–27] vs. 26.4 [23.2–29.6] weeks, <i>p</i> = 0.08). No difference in birthweight, neonatal phototherapy, exchange, or simple transfusion was observed. <b><i>Conclusion:</i></b> This is one of the largest studies comparing techniques to treat fetal anemia. IVT was most performed, other techniques were more likely performed in hydrops, and lower starting hematocrit was seen. Neither technique affected outcomes. This study may suggest that physician’s experience may be the strongest contributor of outcomes.