Severe Hemolytic Disease of the Fetus Treated with Serial Intrauterine Transfusions: A Case Report and Review of Current Management

Abstract

Hemolytic disease of the fetus and newborn (HDFN) is a severe complication of pregnancy caused by maternal alloimmunization to fetal red blood cells, leading to significant perinatal morbidity and mortality. The prognosis is particularly poor in cases complicated by fetal hydrops. Prophylactic administration of anti-D immunoglobulin—during pregnancy, postpartum, and after events causing fetomaternal hemorrhage—has substantially reduced the incidence and severity of Rh-related HDFN. Nevertheless, the condition can still occur, either due to omitted prophylaxis or undetected fetomaternal hemorrhage. Definitive management often requires invasive interventions, including cordocentesis and intrauterine transfusions (IUTs), sometimes repeated multiple times, while the optimal timing of delivery remains uncertain, necessitating a careful balance between prematurity and ongoing fetal risk. We report the case of a 35-year-old multipara whose two most recent pregnancies were complicated by HDFN. The first affected pregnancy had a mild course, whereas the second was severe, necessitating multiple intrauterine transfusions (IUTs) throughout gestation. Despite an extremely low initial fetal hematocrit (4.5%), severe hydrops, and the requirement of six intrauterine transfusions (IUTs) during the pregnancy, the infant was delivered at 36 weeks’ gestation with a favorable postnatal outcome. This case report provides a comprehensive overview of intrauterine transfusion methodology, post-transfusion pregnancy monitoring, timing of successive IUTs, and optimal delivery planning in pregnancies complicated by HDFN.