VALENCIA, Spain—Dick Oepkes, MD, PhD, professor of obstetrics and fetal therapy at Leiden University Medical Center in the Netherlands, outlined important points about the antenatal management of hemolytic disease of the fetus and newborn (HDFN) at the 20th World Congress in Fetal Medicine.
According to his presentation, routine screening should be offered to all pregnant women, and when antibodies are present, typing, titer, and fetal testing should be performed. Women at risk should be referred to a fetal medicine center at 16 weeks of gestation.
Moreover, serial fetal middle cerebral arterial (MCA) Doppler assessment to detect anemia should only be done in high-risk groups and intrauterine transfusion should only be performed when the MCA-peak systolic velocity is above 1.5 MoM.
The second intrauterine transfusion should be done after 2 to 3 weeks and the third, fourth, fifth, and sixth transfusions should be performed at 4- to 5-week intervals. The levels of pre- and post-transfusion hemoglobin and weekly MCA Doppler assessments should be used to individualize transfusion intervals.
Finally, the baby should be delivered at around 37 weeks in a tertiary care center.
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During his lecture, Dr. Oepkes also presented data about the importance of intrauterine transfusions being supervised by a senior operator.
The number of intrauterine transfusions needed to be supervised by a senior operator varies from 30 to 50 procedures, according to one study, Dr. Oepkes reported, adding that experienced operators must perform at least 10 procedures annually to maintain competence.
Finally, he touched on the effect of intravenous immunoglobulin (IVIG), which has been used for many years in very high-risk cases, to postpone the first intrauterine transfusion. “It is still debatable whether this helps or not,” Dr. Oepkes said and added that the procedure does not really seem to offer any real advantage.
HDFN is a rare condition characterized by the mother’s red blood cells or blood group antibodies causing the fetal red blood cells to be destroyed. Intrauterine blood transfusion is considered the most successful treatment for fetal anemia.
Reference
Oepkes D. Antenatal management of hemolytic disease of the fetus and newborn. Oral presentation at: 20th World Congress in Fetal Medicine; June 26, 2023; Valencia, Spain.
