Crawford NEH, et al. - Researchers assessed a 10-year consecutive case series of pregnancies affected by severe, early-onset Rhesus isoimmunization treated with fetal intraperitoneal transfusions (IPTs) before 20 weeks gestation at Wessex Fetal Medicine Unit, Southampton, UK, in order to define the management and perinatal outcomes of these pregnancies. Based on obstetric history and maternal antibody levels at the time of booking, identification of women with fetuses at risk of early-onset fetal anemia (before 20 weeks gestation) was done. Middle cerebral artery peak systolic velocity, as an indicator of fetal anemia, assisted in the decision to initiate transfusion. At the first transfusion, no fetus was hydropic. They assessed 11 fetuses who underwent 45 IPTs. After 33 weeks of gestation, 10/11 (91%) were delivered. In previous studies, a perinatal loss rate of 24% was reported in correlation with early intrauterine transfusion in gestations below 20 weeks using the intravascular route. As per this series, intraperitoneal transfusion seems to be a safe and efficacious treatment for severe fetal anemia at early gestations where vascular access is challenging.