A diagnosis of hemolytic disease of the fetus and newborn (HDFN) can significantly affect your options during pregnancy and birth. After diagnosis, your birth plan will likely need to change according to your healthcare team’s advice to ensure the best outcomes for you and your baby.
Close monitoring and regular imaging will guide your doctor in deciding how and when you should deliver your baby.
HDFN diagnosis and follow-up care during pregnancy
As a result of standard prenatal testing, the risk of HDFN is often identified early in pregnancy. Regular fetal ultrasounds, frequent MCA Doppler scans of the fetus to detect anemia and maternal blood tests to check for antibodies are key to early detection and diagnosis. A confirmed diagnosis will lead to your pregnancy being classified as ‘high-risk’.
Following diagnosis, your baby will be monitored to assess the evolution of HDFN-related symptoms. If anemia persists, medical intervention in the form of intravenous immunoglobulin (IVIG) and intrauterine blood transfusions (IUTs) to prevent the onset of severe anemia will be administered. Steroids to boost lung development in preparation for a potential early delivery may also be given.
Factors to be considered when deciding on the timing of delivery
HDFN-affected pregnancies often require an early delivery, either by induced labor or by cesarean. Your maternal-fetal specialist will assess the health and well-being of the fetus in order to choose the right time for delivery.
Some factors your doctor will consider may include:
Fetal gestational age: Delivery after 37 weeks is preferred, as lung maturity is complete at 36 weeks. However, if urgent treatment is required, delivery can occur as early as 33 weeks. Preterm babies will likely be cared for in the neonatal intensive care unit.
Fetal anemia: If fetal anemia doesn’t respond to treatment and progresses to severe anemia, there is an increased risk of the fetus developing hydrops fetalis. This can cause an enlarged heart, liver or spleen, swelling under the skin, fluid in the abdomen and lungs and cardiac arrest.
Fetal growth, development and well-being: Slowed growth, reduced fetal movement and signs of fetal distress such as a rapid or irregular heartbeat can all contribute to the decision to deliver early.
Your doctor or maternal-fetal specialist will use these factors to help you decide on the safest way to deliver your baby.
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