AbstractDespite routine antenatal anti-D prophylaxis with immunoglobulin, Rh alloimmunization and hemolytic disease of the fetus and newborn continue to occur due to a myriad of reasons. Intrauterine intravascular transfusion (IUT) or fetal blood transfusion is a therapeutic prenatal procedure in which specifically prepared and treated unit of donor red blood cells is injected intravascularly into the umbilical vein under ultrasound guidance. Originally introduced in the year 1963, it continues to be the standard treatment for severe fetal anemia. The objective of this guideline is to provide an evidence-based update of IUT for the perinatal healthcare providers.