This report describes and illustrates a case of a fetal death 2 hours after an ultrasonically guided intravascular intrauterine transfusion. The apparent cause of fetal death was a cord hematoma at the site of puncture, with umbilical vein thrombosis. The hematoma appears to have been related to injection of pancuronium before confirmation of needle placement, resulting in creation of a dead space in the cord adjacent to the puncture site. A total of 68 such procedures performed on 23 fetuses with three fetal deaths (4%) have been reported. This case is the first documented procedure-related death in a consecutive experience of 35 transfusions in 15 fetuses at this institution.