{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T11:03:54Z","timestamp":1778497434390,"version":"3.51.4"},"reference-count":18,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Intrauterine transfusions (IUTs) are the cornerstone in treatment for hemolytic disease of the fetus and newborn (HDFN). It has been suggested that a non\u2010vascular intraperitoneal blood transfusion used in conjunction with an intravascular IUT can slow the decrease in fetal hemoglobin (Hb) levels, potentially extending the interval between transfusions. Our aim was to evaluate the rate of decline in Hb levels and the interval between transfusions using different IUT techniques, including intrahepatic transfusions with and without intraperitoneal transfusion, and transplacental transfusion at the site of the placental cord insertion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study at the Leiden University Medical Center, the national referral center for HDFN, between January 2006 and December 2022. All cases that underwent intrahepatic (with and without intraperitoneal transfusion) and placental cord insertion IUTs during the study period were included. The primary outcome was the decline in Hb levels per week, measured by comparing the Hb level immediately after the IUT with the Hb level before the subsequent IUT or birth. The primary outcome was analyzed using generalized estimating equations with and without adjustment for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 309 fetuses that received a total of 791 IUTs, of which 151 were intrahepatic\u2010only transfusions, 273 were intrahepatic\u2009+\u2009intraperitoneal transfusions and 367 were placental cord insertion transfusions. We found an adjusted mean difference in the decline in Hb levels of 0.48 (95%\u2009CI, 0.29\u20130.66)\u2009g\/dL\/week between the group that underwent intrahepatic\u2010only transfusion and the group that underwent intrahepatic\u2009+\u2009intraperitoneal transfusion (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The adjusted mean difference between the intrahepatic\u2010only IUT group and the placental cord insertion IUT group was 0.49 (95%\u2009CI, 0.05\u20130.94)\u2009g\/dL\/week (<jats:italic>P<\/jats:italic>\u2009=\u20090.030). The median interval to the next IUT for the total cohort was 21 (interquartile range (IQR), 18\u201328) days. Similarly, in the intrahepatic\u2010only and placental cord insertion IUT groups, the median interval to the next IUT was 21 (IQR, 19\u201328) and 21 (IQR, 15\u201326) days, respectively. In the intrahepatic\u2009+\u2009intraperitoneal transfusion group, the median interval was slightly higher (26 (IQR, 21\u201328) days).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Decline in Hb levels was slower when using intrahepatic\u2009+\u2009intraperitoneal transfusion compared with other IUT techniques and seemed to prolong the interval between IUT procedures. The potential clinical advantages of the intrahepatic\u2009+\u2009intraperitoneal transfusion technique need to be weighed against the increased complexity and extended duration of the procedure on an individual basis. \u00a9 2025 The Author(s). <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.29201","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T05:49:44Z","timestamp":1743313784000},"page":"589-596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Comparison of intrauterine transfusion techniques in hemolytic disease of the fetus and newborn"],"prefix":"10.1002","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8981-9500","authenticated-orcid":false,"given":"R. M.","family":"van 't Oever","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"},{"name":"Translational Immunohematology, Sanquin Research and Landsteiner Laboratory Amsterdam UMC  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V. M.","family":"van Duijn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Slaghekke","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0443-1997","authenticated-orcid":false,"given":"M. C.","family":"Haak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. P.","family":"de Winter","sequence":"additional","affiliation":[{"name":"Translational Immunohematology, Sanquin Research and Landsteiner Laboratory Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Willem\u2010Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Willem\u2010Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"de Haas","sequence":"additional","affiliation":[{"name":"Translational Immunohematology, Sanquin Research and Landsteiner Laboratory Amsterdam UMC  Amsterdam The Netherlands"},{"name":"Department of Hematology Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Le Cessie","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Leiden University Medical Center  Leiden The Netherlands"},{"name":"Department of Biomedical Data Sciences Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. J. T.","family":"Verweij","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Division of Fetal Therapy Leiden University Medical Center  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5674"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2017.1305265"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.07.014"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17319"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000328683"},{"issue":"2","key":"e_1_2_7_7_1","first-page":"129","article-title":"Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14\u2009years experience in Leuven","volume":"7","author":"Pasman SA","year":"2015","journal-title":"Facts Views Vis Obgyn"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(24)00314-4"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000263434"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000263385"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(84)90683-5"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.01.059"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(89)90910-1"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31826d7dc1"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5355"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000499972"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(81)90543-3"},{"issue":"6","key":"e_1_2_7_18_1","first-page":"749","article-title":"Transplacental fetal hemorrhage after amniocentesis","volume":"66","author":"Bowman JM","year":"1985","journal-title":"Obstet Gynecol"},{"issue":"5","key":"e_1_2_7_19_1","first-page":"839","article-title":"Fetomaternal hemorrhage following funipuncture: increase in severity of maternal red\u2010cell alloimmunization","volume":"84","author":"Bowman JM","year":"1994","journal-title":"Obstet Gynecol"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.29201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T04:16:38Z","timestamp":1755749798000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.29201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":18,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/uog.29201"],"URL":"https:\/\/doi.org\/10.1002\/uog.29201","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]},"assertion":[{"value":"2024-06-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}