Background: Intrauterine transfusion (IUT) is the accepted standard for management of severe fetal anaemia. However, fetal transfusion may be associated with procedural complications such as fetal demise. There is a paucity of recent data on outcomes for severe fetal anaemia in Australia as compared with published outcomes from large international centres. Aims: To review the indications for and the procedural, obstetric and neonatal outcomes following intrauterine transfusion for fetal anaemia conducted at the New South Wales Fetal Therapy Centre (NSW FTC). Materials and Methods: Retrospective cohort study conducted between 2005 and 2017 of the outcomes of 85 IUT procedures (39 pregnancies). Data collected included maternal demographics, procedural and obstetric details and short-term neonatal outcomes. Results: Complete outcome data were available for 36/39 pregnancies. Red cell antibodies were the main indication for fetal transfusion (79%, predominantly D, Kell and other Rhesus antibodies) with parvovirus accounting for 8% of procedures. IUT was associated with a pregnancy loss rate of 1.2%/procedure, amounting to 2.6%/ pregnancy. Fetal losses were limited to those complicated by hydrops prior to IUT (3/10 hydrops vs 0/26 non-hydropic; P = 0.003). Conclusions: Procedural outcomes at NSW FTC compare favourably with international centres (1.1-8.7% procedural loss rate). However, this comparison is limited, as no procedures were performed during the last 24 months of the study. Given this, a nationwide audit is recommended to help guide appropriate centralisation of procedures and thereby maximise clinician experience and outcome.

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Purpose Middle Cerebral Artery Peak Systolic Velocity (MCA‐PSV) is the main tool for determining need for and timing of intrauterine transfusions (IUT) for severe fetal anaemia. It has been suggested that steroids temporarily decrease MCA‐PSV, potentially increasing false‐negative MCA‐PSV findings in anaemic fetuses. We therefore aimed to assess whether maternal corticosteroid administration prior to IUT is associated with clinically significant temporary decreases in MCA‐PSV. Methods Retrospective review 2005–2016 of steroid provision prior to IUT, with correlation of MCA‐PSV pre‐ and post‐steroid administration and haemoglobin at IUT. Results In 23 identified cases, there was no significant difference between average MoM pre‐ and post‐steroid (1.71 ± 0.41 vs. 1.66 ± 0.38, −2.9% mean, P = 0.4). There was also no significant difference between pre‐ and post‐steroid MoM taken within 3 days of each other (n = 19, P = 0.21). However, post‐steroid MCA‐PSV decreased by >15% in 6/23 cases (A‐B zone in two cases, B‐C zone in one case). Conclusions This study found no sizeable, generalised effect of corticosteroid administration on MCA‐PSV readings in the potentially anaemic fetus. A minority showed substantial shifts where reliance on post‐steroid MCA‐PSV could have unfavourably altered clinical management. Ultimately, further large‐scale research is required before we can discount the potential impact of steroids on MCA‐PSV values.