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The fetus is vulnerable to hemodynamic alterations and transfusion\u2010related adverse events; therefore, special consideration must be given to blood component selection and modification. There is widespread IUT practice variability, and existing guidance primarily relies on expert opinion and single center experiences.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>Experts in Maternal Fetal Medicine, Pediatric Hematology, and Transfusion Medicine from centers across the United States, collectively performing about 120 IUT annually, offer a multidisciplinary perspective on the performance of IUT and preparation of blood components. This perspective includes strategies for identifying an at\u2010risk fetus, communicating between disciplines, determining the necessary blood volume, selecting and processing blood components, documenting the procedure in medical record, and managing the neonate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Identifying an at\u2010risk fetus relies on review of the clinical history, non\u2010invasive monitoring, and laboratory evaluation. We recommend the use of relatively fresh, group O, cytomegalovirus\u2010safe, freshly irradiated, red blood cells (RBC) that are Hemoglobin S negative and antigen\u2010negative for any maternal antibody, if indicated. These RBC units should be concentrated to remove additives and increase the hematocrit thus minimizing fluctuations in fetal volume status. The units intended for IUT should be labeled clearly and the documentation of transfusion differentiated in the maternal medical record.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>An awareness of the technical, logistical, and regulatory considerations for IUT performance will facilitate improved communication and patient care, especially when rare units of RBC are required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17570","type":"journal-article","created":{"date-parts":[[2023,10,27]],"date-time":"2023-10-27T10:40:30Z","timestamp":1698403230000},"page":"2214-2224","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["How do we perform intrauterine transfusions?"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1910-2800","authenticated-orcid":false,"given":"Elizabeth P.","family":"Crowe","sequence":"first","affiliation":[{"name":"Department of 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