Success Rate of Intrauterine Transfusion and Associated Factors in Rh negative Mothers at St. Paul’s Hospital Millennium Medical College from October 2023 to June 2025

Abstract

Abstract Background: Intrauterine transfusion (IUT) is a key intervention for severe fetal anemia most often due to Rh-alloimmunization. While global survival rates range from 60%–97%, outcomes depend on gestational age, severity, and operator skill. In Ethiopia, Rh disease persists due to limited access to anti-D prophylaxis, and IUT data remain scarce. Objective: The aim of this study was to assess the success rate of IUT and factors influencing the success of IUT among Rh-negative mothers at St. Paul’s Hospital Millennium Medical College (SPHMMC) between October 2023–June 2025. Method: An institution-based retrospective chart review was conducted at SPHMMC (Sept 20, 2025–Jan 2, 2026) on all eligible Rh-negative mothers who underwent IUT from Oct 2023–Jun 2025 (~200 procedures), with data extracted from charts and logs, quality assured, analyzed in SPSS using descriptive statistics, chi-square/Fisher’s exact test and T-test to assess associations, and logistic regression to identify predictors of IUT success. Result: Of the 107 pregnancies included in the study, 61.7% of neonates survived to seven days postpartum. Fetal hydrops was present at the first transfusion in 64.5% of cases and was strongly associated with poor neonatal outcomes. Larger transfusion volumes were linked to lower neonatal survival, reflecting advanced disease severity at presentation. Repeated intrauterine transfusions were associated with improved poor outcome, with an average of 2.8 transfusions per pregnancy. Neonatal morbidity was high, with 77.6% of neonates requiring NICU admission. The most common early neonatal complications were neonatal jaundice followed by respiratory distress syndrome. Conclusion and recommendation: To improve neonatal outcomes following intrauterine transfusion, early identification of Rh alloimmunization and timely referral before the development of fetal hydrops are essential. Serial intrauterine transfusions should be initiated when indicated, with careful calculation of transfusion volume based on fetal condition. Ensuring continuous availability of compatible blood products and strengthening neonatal care services, particularly NICU support, are crucial to reducing complications and improving survival. Keywords: Rh alloimmunization, Intrauterine transfusion, Success rate, Fetal anemia