Some conditions can be treated while the baby is still in the womb. The most established is fetal anaemia, where the baby does not have enough red blood cells. Untreated, severe anaemia can cause heart strain and fluid build-up (hydrops), but a blood transfusion given directly to the baby before birth can correct it and allow the pregnancy to continue.
Intrauterine transfusion (IUT) is a carefully planned, ultrasound-guided procedure. It sits within a wider programme of monitoring that begins well before any needle is used: regular Doppler scans of the baby’s brain circulation pick up anaemia early, so treatment is timed rather than rushed.
Dr. Devang Patel holds the FNB fellowship in High Risk Pregnancy & Perinatology, the first awarded in Gujarat, and trained in maternal-fetal medicine at Fernandez Hospital, Hyderabad. He performs intrauterine transfusion and fetal reduction at Divine Women’s Hospital, Gota, with obstetric, anaesthesia and neonatal teams available round the clock.
What fetal anaemia is and why it happens
In Rh disease, an Rh-negative mother who has been exposed to Rh-positive blood, usually during an earlier birth, miscarriage or procedure, makes antibodies against the Rh factor. In a later pregnancy these antibodies cross the placenta and break down the baby’s red cells if the baby is Rh positive.
Other antibodies such as anti-Kell, anti-c and anti-E can do the same; anti-Kell also suppresses red cell production, so it can cause anaemia at lower antibody levels. Parvovirus B19 (slapped cheek infection) temporarily stops the baby’s bone marrow making red cells. Rarer causes include bleeding from the baby into the mother’s circulation and inherited conditions such as alpha-thalassaemia major.
Conditions treated with fetal therapy
- Rh (anti-D) alloimmunisation, the commonest reason for IUT in India
- Other red cell antibodies, such as anti-Kell, anti-c or anti-E
- Parvovirus B19 infection with fetal anaemia or hydrops
- Fetal anaemia from feto-maternal haemorrhage or other causes found on Doppler
- Triplet and higher-order pregnancies, where fetal reduction may be considered
- Selected complications of monochorionic twins, assessed and referred onwards for laser treatment where needed
How fetal anaemia is detected
Every pregnant woman has her blood group and antibody screen (indirect Coombs test, ICT) checked at booking. If antibodies are found, their level (titre) is measured every two to four weeks. For anti-D, a titre of 1 in 16 or more, or a quantified level above about 4 IU/mL, usually starts Doppler monitoring. Testing the father’s blood group helps tell whether the baby can be affected.
The baby is then monitored with middle cerebral artery (MCA) Doppler, usually every one to two weeks from around 16 to 18 weeks. An anaemic baby’s blood is thinner and flows faster, so a peak systolic velocity above 1.5 multiples of the median (MoM) for the week predicts moderate or severe anaemia with a high detection rate. This has largely replaced repeated amniocentesis for monitoring.
Signs of fluid around the heart, lungs, abdomen or under the skin (hydrops) mean anaemia is severe and treatment is urgent.
With careful Doppler monitoring, most anaemic babies are identified and treated before hydrops develops.
Treatment options compared
The right approach depends on the cause, the gestation and how severe the anaemia is. The table summarises the main options.
| Option | How it works | Suited to |
|---|---|---|
| Doppler surveillance | MCA scans every 1–2 weeks with antibody titres | Mild or no anaemia; MCA below 1.5 MoM |
| Intravascular IUT | Blood given into the umbilical vein under ultrasound | Moderate or severe anaemia from about 18 to 35 weeks |
| Intraperitoneal transfusion | Blood given into the baby’s abdomen, absorbed over days | Very early gestation when cord access is difficult |
| IVIG for the mother | Immunoglobulin infusions to dampen antibody effect | Severe disease with early loss in a previous pregnancy |
| Planned delivery | Birth with neonatal care, phototherapy, exchange transfusion | From about 35–37 weeks, or when IUT risks outweigh benefits |
The intrauterine transfusion procedure
Under continuous ultrasound guidance, a fine needle is passed through the mother’s abdomen into the umbilical vein, usually where the cord joins the placenta, or into the vein inside the baby’s liver. A first sample measures the baby’s haemoglobin within minutes. Specially prepared blood, group O Rh negative, cross-matched to the mother, screened, irradiated and packed to a high concentration, is then given slowly, and a final sample checks the result.
The mother is awake, with local anaesthetic at the needle site. The baby is often given a small injection to keep still. The procedure usually takes 30 to 60 minutes, and after 24 to 26 weeks it is done close to the operation theatre so that emergency delivery is possible if needed. Transfusions are typically repeated every two to three weeks until about 34 to 35 weeks.
Risks and how they are reduced
Like any procedure in pregnancy, IUT carries risks: bleeding from the puncture site, a temporary slowing of the baby’s heart rate, infection, leaking of fluid, preterm labour and, uncommonly, pregnancy loss, reported at around 1 to 3% per procedure in published series. The risk is higher before 20 weeks and when the baby is already hydropic.
Risks are reduced by careful choice of needle site, continuous ultrasound, sterile technique, antibiotic cover where indicated, steroid injections for the baby’s lungs from 24 weeks, and anti-D or other antibody status being known in advance. Every risk is discussed before you consent.
Recovery, birth and after
Most women go home the same day or the next morning after a scan confirms the baby is well. A follow-up MCA Doppler is done within one to two weeks to time the next transfusion. Birth is usually planned at 35 to 37 weeks, often by induction, with the neonatal team present.
Babies treated for Rh disease may need phototherapy for jaundice, and some need an exchange transfusion or further blood in the first two to three months, because transfused red cells gradually run down while the antibodies persist. Long-term development in babies treated without severe hydrops is reported to be normal in the large majority.
For the mother, recovery is quick: light activity the next day, no heavy lifting for 48 hours, and a check of the needle site. You are given a direct line to call if you notice fluid leakage, bleeding, fever or reduced movements, and the hospital’s 24×7 emergency and labour care means there is always someone to see you.
Cases of possible fetal anaemia are seen promptly at Divine Women’s Hospital, Gota, because MCA findings can change within days. The blood bank is informed in advance so that suitably prepared blood is ready on the planned day.
Fetal reduction and preventing Rh disease
In triplet and higher-order pregnancies, the risk of very early birth is high for all the babies. Fetal reduction, usually performed at 11 to 14 weeks after a detailed scan and NT assessment, may be offered to reduce those risks. It is a sensitive decision made only by the couple after unhurried counselling, within the provisions of the MTP Act.
Most Rh disease can be prevented. Rh-negative mothers with a negative ICT are offered anti-D at around 28 weeks, within 72 hours of the birth of an Rh-positive baby, and after any bleeding, miscarriage, ectopic pregnancy, abdominal injury or procedure. In future pregnancies after Rh disease, monitoring starts early, as the disease tends to begin earlier and be more severe.
A note on the PCPNDT Act
Pre-natal sex determination is prohibited in India under the PCPNDT Act. The sex of the baby is not detected or disclosed at any scan.
Your care, step by step
- Antibody and partner testingYour antibody type and titre, and your partner’s blood group, establish whether the baby is at risk.
- Doppler monitoringMCA Doppler scans every one to two weeks track the baby for early signs of anaemia.
- Counselling and consentThe reason for treatment, the procedure, its risks and the alternatives are explained in detail.
- TransfusionPrepared blood is given to the baby through the umbilical vein under continuous ultrasound guidance.
- Follow-up and birth planRepeat Doppler times further transfusions, and delivery and newborn care are planned with the neonatal team.
When to book a visit
- You are Rh negative and your antibody (ICT) test is positive
- You have anti-Kell, anti-c or other red cell antibodies
- A previous baby had severe jaundice, needed exchange transfusion, or had hydrops
- An MCA Doppler scan suggests fetal anaemia
- You were exposed to or had a parvovirus (slapped cheek) infection in pregnancy
- You are expecting triplets or more
Warning signs - get same-day care
- Your baby is moving less or the pattern of movement has changed
- Vaginal bleeding or leaking of fluid after a procedure
- Fever, chills or abdominal pain in the days after a transfusion
- Regular painful tightenings or contractions
- A rapidly enlarging bump with breathlessness
Labour and emergency care are available 24 × 7. Call the hospital and come in directly.
Myths and facts
Myth: An Rh-negative mother cannot have a healthy baby.
With anti-D prevention, most Rh-negative mothers never form antibodies, and those who do can be monitored and treated.
Myth: Rh disease affects the first pregnancy.
It usually affects later pregnancies, after exposure to Rh-positive blood. That is why anti-D is given in the first pregnancy.
Myth: Once anti-D antibodies form, an injection of anti-D will clear them.
Anti-D prevents antibodies from forming; it does not remove existing ones. Monitoring and, if needed, IUT are the next steps.
Myth: Early delivery is always safer than a transfusion.
Before about 34 weeks, the risks of prematurity usually outweigh those of IUT. Transfusion lets the baby stay in the womb and gain maturity.
Frequently asked questions
What is an intrauterine transfusion?
It is a blood transfusion given to the baby in the womb, through a fine needle guided by ultrasound into the umbilical cord or a vein in the baby’s liver. It treats fetal anaemia.
How many transfusions will my baby need?
Anaemia from parvovirus often needs only one or two, because the baby recovers once the infection passes. Anaemia from Rh antibodies usually needs repeated transfusions every two to three weeks until delivery, often three to five in total.
What is the MCA Doppler test in Rh-negative pregnancy?
A scan that measures how fast blood flows in an artery in the baby’s brain. Faster flow suggests anaemia. It lets the baby be monitored without a needle and shows when a transfusion is needed.
What ICT titre is dangerous in pregnancy?
For anti-D, a titre of 1 in 16 or more is generally considered significant and starts MCA Doppler monitoring. For anti-Kell, any level is taken seriously. The titre guides monitoring; the Doppler guides treatment.
Is intrauterine transfusion safe?
It is an established treatment, and for a baby with severe anaemia the benefits clearly outweigh the risks. It carries a small risk of complications, including pregnancy loss, explained to you before the procedure.
Is the procedure done under anaesthesia?
Local anaesthetic is used at the needle site and you remain awake. Most women describe pressure and mild cramping rather than sharp pain.
Will my baby need treatment after birth?
Many babies need phototherapy for jaundice, and some need an exchange transfusion or further blood in the first weeks. The neonatal team is involved in planning before delivery.
Can I have anti-D if I already have antibodies?
If you already have anti-D antibodies, anti-D injections are not useful. If you have a different antibody, such as anti-c, you may still need anti-D to prevent anti-D forming.
Will Rh disease be worse in my next pregnancy?
It often starts earlier and can be more severe. Early booking, antibody titres from the first trimester and MCA Doppler from about 16 weeks allow timely care.
Should I be worried about parvovirus if a child at home has a rash?
Most adults are already immune. If you are exposed, a blood test shows whether you are immune or recently infected. If infection is confirmed, MCA Doppler scans every one to two weeks for 8 to 12 weeks watch for anaemia, which usually responds to one transfusion.