If you’re living in a rural area, or in an area with limited access to specialist medical care, a diagnosis of hemolytic disease of the fetus and newborn (HDFN) during pregnancy could bring additional challenges.
Prenatal care is key to successful outcomes for your baby, and your primary healthcare provider will monitor you carefully throughout your pregnancy. In the case of complications, you may need to be transferred to a specialist center. It is likely that you will deliver your baby non-locally.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor (Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.) during pregnancy. Numerous antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. to RBC antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. can be linked to HDFN, such as those from the ABO and Rh blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN. systems.
Prenatal care
In pregnancies at risk of HDFN, or in the case of HDFN detection, prenatal care is of utmost importance. In rural areas, reduced access to maternity care can lead to poorer outcomes, with higher risks of complications for mother and baby.
In cities or urban areas where specialist centers are more available, referral to a maternal fetal specialist is standard in HDFN-affected pregnancies. However, in less medically serviced areas, prenatal care will often be given by the local GP or midwife, where the understanding of HDFN may be less comprehensive, due to its rare occurrence.
While the pregnant mother is unaffected by HDFN, the fetus will require close monitoring to allow for timely medical intervention, if the need arises. Regular blood tests and ultrasounds will keep an eye on your baby’s development, growth and HDFN-related symptoms. If local access to ultrasounds is difficult, you will be required to travel to a larger hospital.
If the pregnancy is complication-free, and the fetus avoids the dangers of severe anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells., the risks are relatively low, and your local doctor can continue to be your primary physician. However, in the case of fetal distress and HDFN-related complications, urgent transfer to a more specialized center may be required to ensure treatment.
Delivery and post-natal care
Where you give birth will depend largely on the health and well-being of your baby during pregnancy. High-risk pregnancies – and in particular, HDFN-affected pregnancies – often result in preterm cesarean deliveries and time spent in the neonatal intensive care unit (NICU). Your healthcare provider will advise you on the best option for your personal situation. In most cases, HDFN deliveries take place at a specialized medical center, with the capacity to offer acute neonatal care.
Following delivery, the greatest risk to the newborn comes from severe jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes., which can lead to brain damage if left untreated, and severe anemia which can result in heart failure. Ideally, this kind of specialized neonatal care should be performed by a dedicated multidisciplinary team. Immediate treatment is essential to ensuring the newborn doesn’t suffer any long-term consequences of HDFN-related symptoms.
A higher-resource hospital will be better equipped to provide this essential care and thus, contribute to better outcomes.
