Intrauterine Transfusion for Parvovirus B19–Related Fetal Anemia: A Comparative Cohort Study of Hydropic and Non-Hydropic Outcomes

INTRODUCTION: To evaluate the efficacy and safety of intrauterine transfusion (IUT) in fetuses with parvovirus B19–related anemia, and to compare prenatal, procedural, and neonatal outcomes between hydropic and non-hydropic presentations.
METHODS: This retrospective cohort included 41 pregnancies with confirmed fetal parvovirus B19 infection managed between December 2022 and December 2024 in Department of perinatology Ankara Etlik City Hospital. Fetuses were stratified based on the presence of hydrops. MCA Doppler values, transfusion parameters, hematologic response, and perinatal outcomes were compared between hydropic (n=29) and non-hydropic (n=12) groups.
RESULTS: IUT was performed in 18 fetuses (14 hydropic, 4 non-hydropic). The median gestational age at first IUT was 26 weeks in hydropic and 27 weeks in non-hydropic cases (p=0.513). Pre-transfusion hemoglobin was significantly lower in hydropic fetuses (4.7 vs. 8.2 g/dL, p=0.010), while post-transfusion levels did not differ significantly (p=0.670). MCA-PSV values were significantly higher in hydropic cases (median 1.67 vs. 1.35 MoM, p=0.049) and showed significant improvement following transfusion. Fetal pH values increased after IUT, although this change was not statistically significant. No procedure-related fetal deaths occurred. Minor complications were observed in 21.4% of hydropic and 25% of non-hydropic fetuses. Live birth was significantly less frequent in hydropic fetuses (48.2% vs. 83.3%, p=0.044), and perinatal mortality was higher (37.9% vs. 16.7%, p=0.047).
DISCUSSION AND CONCLUSION: Intrauterine transfusion is a safe and effective treatment for parvovirus B19–related fetal anemia. Although hydropic fetuses remain at elevated risk, timely transfusion—guided by MCA Doppler surveillance—can significantly improve survival and reduce perinatal morbidity.

Keywords: Parvovirus B19, fetal anemia, intrauterine transfusion, hydrops fetalis, MCA Doppler, fetal therapy