{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:40:22Z","timestamp":1765186822978,"version":"3.46.0"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>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\u2014during pregnancy, postpartum, and after events causing fetomaternal hemorrhage\u2014has 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\u2019 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.<\/jats:p>","DOI":"10.3390\/life15121875","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:17:36Z","timestamp":1765185456000},"page":"1875","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe Hemolytic Disease of the Fetus Treated with Serial Intrauterine Transfusions: A Case Report and Review of Current Management"],"prefix":"10.3390","volume":"15","author":[{"given":"Olga","family":"Olejniczak","sequence":"first","affiliation":[{"name":"Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland"},{"name":"Doctoral School, Poznan University of Medical Sciences, 60-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2339-9005","authenticated-orcid":false,"given":"Jakub","family":"Kornacki","sequence":"additional","affiliation":[{"name":"Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5492-8651","authenticated-orcid":false,"given":"Ewa","family":"Wender-O\u017cegowska","sequence":"additional","affiliation":[{"name":"Department of Reproduction, Chair of Reproduction and Perinatal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2147\/PHMT.S327032","article-title":"Hemolytic Disease of the Newborn: A Review of Current Trends and Prospects","volume":"12","author":"Myle","year":"2021","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_2","unstructured":"Rosenkrans, D., Zubair, M., and Doyal, A. (2025, August 30). Rh Blood Group System, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK594252\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1046\/j.1537-2995.1990.30490273444.x","article-title":"Fetomaternal hemorrhage: Incidence, risk factors, time of occurrence, and clinical effects","volume":"30","author":"Sebring","year":"1990","journal-title":"Transfusion"},{"key":"ref_4","unstructured":"Dean, L. (2025, August 30). Hemolytic disease of the newborn, Blood Groups and Red Cell Antigens, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK2266\/."},{"key":"ref_5","unstructured":"(2025, August 31). Prognosis and Management in Subsequent Rh Alloimmunized Pregnancies\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/35261671\/."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletins\u2014Obstetric (2017). Practice Bulletin No. 181: Prevention of Rh D Alloimmunization. Obstet. Gynecol., 130, e57.","DOI":"10.1097\/AOG.0000000000002232"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2147\/JBM.S214118","article-title":"Prevalence and specificity of clinically significant red cell alloantibodies in pregnant women\u2014A study from a tertiary care hospital in Southeast Michigan","volume":"10","author":"Moinuddin","year":"2019","journal-title":"J. Blood Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/ijgo.13459","article-title":"FIGO\/ICM guidelines for preventing Rhesus disease: A call to action","volume":"152","author":"Visser","year":"2021","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S1701-2163(16)31006-4","article-title":"Prevention of Rh alloimmunization","volume":"25","author":"Fung","year":"2003","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1097\/OGX.0000000000001338","article-title":"Prevention of Maternal Rh D Alloimmunization: A Comparative Review of Guidelines","volume":"79","author":"Boureka","year":"2024","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"de Winter, D.P., Kaminski, A., Tjoa, M.L., and Oepkes, D. (2023). Hemolytic disease of the fetus and newborn: Systematic literature review of the antenatal landscape. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-022-05329-z"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"161.e1","DOI":"10.1016\/j.ajog.2007.10.788","article-title":"The usefulness of middle cerebral artery Doppler assessment in the treatment of the fetus at risk for anemia","volume":"198","author":"Moise","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1046\/j.1469-0705.1995.05060400.x","article-title":"Diagnosis of fetal anemia with Doppler ultrasound in the pregnancy complicated by maternal blood group immunization","volume":"5","author":"Mari","year":"1995","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1080\/00016340902763228","article-title":"Management of red cell alloimmunized pregnancies using conventional methods compared with that of middle cerebral artery peak systolic velocity","volume":"88","author":"Sau","year":"2009","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1080\/14767050802037787","article-title":"Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization","volume":"21","author":"Maciuleviciene","year":"2008","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1111\/1471-0528.18008","article-title":"The Use of Novel Therapies in the Management of Haemolytic Disease of the Fetus Newborn (HDFN): Scientific Impact Paper No 75","volume":"132","author":"Cordell","year":"2025","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1067\/mob.2003.208","article-title":"Is Rh immune globulin needed in early first-trimester abortion? A review","volume":"188","author":"Jabara","year":"2003","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.ajem.2006.01.020","article-title":"Do Rh-negative women with first trimester spontaneous abortions need Rh immune globulin?","volume":"24","author":"Hannafin","year":"2006","journal-title":"Am. J. Emerg. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2024). ACOG Clinical Practice Update: Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation. Obstet. Gynecol., 144, e140\u2013e143.","DOI":"10.1097\/AOG.0000000000005733"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/oxfordjournals.humrep.a136340","article-title":"Feto-maternal transfusion after chorionic villus sampling: Clinical implications","volume":"1","author":"Brambati","year":"1986","journal-title":"Hum. Reprod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/j.1879-3479.1978.tb00425.x","article-title":"Fetal-maternal hemorrhage after amniocentesis: Incidence, degree and ramifications","volume":"16","author":"Goldstein","year":"1978","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_22","first-page":"302","article-title":"Mild-to-moderate foeto-maternal haemorrhage in the third trimester and at term of pregnancy: Quantitative determination and clinical-diagnostic evaluation","volume":"16","author":"Beneventi","year":"2018","journal-title":"Blood Transfus."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1111\/j.1537-2995.2011.03536.x","article-title":"Fetomaternal hemorrhage in normal vaginal delivery and in delivery by cesarean section","volume":"52","author":"Lubusky","year":"2012","journal-title":"Transfusion"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1515\/JPM.2004.047","article-title":"Risk factors for fetal-to-maternal transfusion in Rh D-negative women\u2013results of a prospective study on 942 pregnant women","volume":"32","author":"David","year":"2004","journal-title":"J. Perinat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1111\/jog.12959","article-title":"Occult fetomaternal hemorrhage in women with pathological placenta with respect to permeability","volume":"42","author":"Umazume","year":"2016","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_26","first-page":"CD000021","article-title":"Anti-D administration after childbirth for preventing Rhesus alloimmunisation","volume":"1997","author":"Crowther","year":"1997","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","first-page":"109","article-title":"Recommendations for the prevention and treatment of haemolytic disease of the foetus and newborn","volume":"13","author":"Bennardello","year":"2015","journal-title":"Blood Transfus."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1177\/1753495X15597631","article-title":"Rare problems with RhD immunoglobulin for postnatal prophylaxis after large fetomaternal haemorrhage","volume":"8","author":"Biscoe","year":"2015","journal-title":"Obstet. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"611","DOI":"10.5694\/j.1326-5377.2006.tb00414.x","article-title":"Postpartum anti-D: Can we safely reduce the dose?","volume":"184","author":"Augustson","year":"2006","journal-title":"Med. J. Aust."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Urgessa, F., Tsegaye, A., Gebrehiwot, Y., and Birhanu, A. (2014). Assessment of feto-maternal hemorrhage among rhesus D negative pregnant mothers using the kleihauer-betke test (KBT) and flow cytometry (FCM) in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-358"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"102449","DOI":"10.1016\/j.jogc.2024.102449","article-title":"Guideline No. 448: Prevention of Rh D Alloimmunization","volume":"46","author":"Wong","year":"2024","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.htct.2023.07.013","article-title":"Effective management of foetal anaemia in Rh(D) alloimmunised pregnant women with intrauterine transfusion: A Systematic Review","volume":"46","author":"Prescott","year":"2024","journal-title":"Hematol. Transfus. Cell Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1002\/uog.17319","article-title":"Complications of intrauterine intravascular blood transfusion: Lessons learned after 1678 procedures","volume":"50","author":"Zwiers","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1002\/uog.20273","article-title":"Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: Systematic review and meta-analysis","volume":"54","author":"Figueras","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/uog.14772","article-title":"Determination of optimal timing of serial in-utero transfusions in red-cell alloimmunization","volume":"46","author":"Friszer","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1002\/pd.6670","article-title":"Safety of Intrauterine Transfusion Performed Beyond 34 weeks of Gestation","volume":"44","author":"Youssefzadeh","year":"2024","journal-title":"Prenat. Diagn."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Peretz, A.C., Tsaitlin-Mor, L., Leibner, G., Cohen, S.M., Amosi-Victor, D., Haham, N., Shwartz, T., Yanai, N., Porat, S., and Yagel, S. (2025). Late vs. Early Intrauterine Blood Transfusion in Fetal Anemia: Impact on Maternal and Neonatal Outcomes. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1614989"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e2454330","DOI":"10.1001\/jamanetworkopen.2024.54330","article-title":"Variations and Opportunities in Postnatal Management of Hemolytic Disease of the Fetus and Newborn","volume":"8","author":"Verweij","year":"2025","journal-title":"JAMA Netw. Open"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1875\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T09:33:53Z","timestamp":1765186433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1875"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["life15121875"],"URL":"https:\/\/doi.org\/10.3390\/life15121875","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}