Objective: The aim of the study was to report pregnancy and fetal outcomes of Rhesus (Rh)-negative pregnancy at a tertiary care teaching hospital. Materials and methods: Prospective observational study was carried out on all Rh-negative women over 3 years period. On the basis of the evolution of indirect Coombs test (ICT), titer and middle cerebral artery peak systolic velocity (MCA-PSV) value, women were categorized into five groups. In the group with ICT >1:32 and MCA-PSV >1.5, multiple of median (MOM) or any features of hydrops underwent intrauterine transfusion (IUT). Pregnancy outcomes, neonatal outcomes, and procedure-related adverse events were analyzed. Results: A total of 496 women were recruited, out of which 411 were non-alloimmunized, and 85 were alloimmunized. Out of 85 alloimmunized pregnancies, 47 fetuses underwent 148 IUT. The overall perinatal mortality was 1/47, while adverse procedure-related complication was nil in fetuses who underwent IUT. In the IUT group without hydropic fetuses, there was no mortality, but 100% of newborns underwent phototherapy, and 30% underwent exchange transfusion, which was better than the previous studies. In the IUT group with hydropic fetuses, one fetus had mortality out of seven has a cumulative perinatal loss rate of 14%. The procedure-related complication rate was 4.7%. Conclusion: In the absence of fetal hydrops, IUT has a good prognosis with 100% fetus survival in our center. Advancement in neonatal management [concomitant use of phototherapy and intravenous immunoglobulin (IVIG)] of IUT-received fetuses has significantly reduced morbidity related to hemolytic disease of the fetus and newborn (HDFN). Early detection of pregnancy at risk of fetal anemia using ICT titer and MCA-PSV trend and timely management of fetus at risk of anemia using IUT at fetal medicine center leads to a favorable outcome.