High-risk pregnancies require additional medical support and care management of mother and baby. In managing hemolytic disease of the fetus and newborn (HDFN) pregnancies, the involvement of a specialist team of maternal-fetal healthcare professionals is key to avoiding severe outcomes and even fetal death.
HDFN is a rare red blood cell disorder that can arise in pregnancy due to blood type or factor incompatibility between a mother and her baby. Most commonly caused by Rh or ABO incompatibility, HDFN triggers an immune response whereby the mother develops antibodies that cross the placenta and attack her baby’s red blood cells.
In utero, anemia is the most common symptom, with the fetus at risk of developing complications such as hydrops fetalis (swelling of organs and tissue) and heart failure. Post-delivery, the newborn can develop complications like respiratory difficulties, severe jaundice and kernicterus (neurological damage).
While HDFN can be prevented, cases still occur, and specialist care and medical facilities are essential to ensure early diagnosis and timely treatment.
Learn more about HDFN treatment and care
A multidisciplinary team
As HDFN is a rare disease, knowledge gaps often exist in obstetric care providers. This is why specialized care for pregnancies affected by HDFN from a multidisciplinary team is so important. Of course, in lower-resource countries or areas, this may not always be possible. Lack of resources and funding for screening, preventative measures, diagnostic tools and treatment has been shown to increase morbidity and mortality in HDFN-affected babies.
Routine prenatal blood screening identifies the potential risk of HDFN during pregnancy. Ideally, an at-risk pregnant mother will then be referred to a maternal-fetal medicine practitioner, an obstetrician with specialized training in high-risk pregnancies who will lead and coordinate a personalized care plan.
The exact composition of a specialist care team will vary between hospitals or treatment centers and will also depend on individual needs and complications. In most cases, it may include fetal medicine specialists, obstetricians, neonatologists, sonographers, fetal nurse coordinators, laboratory technicians, blood bank personnel and more.
The importance of a maternal-fetal medicine specialist and multidisciplinary team for HDFN pregnancies cannot be overstated.
Diagnosis and treatment
Care of a pregnant mother and her baby, at risk of or affected by HDFN, involves several different specialists, particularly in the diagnosis and treatment of HDFN. Timely referral to a maternal-fetal medicine center significantly improves outcomes.
Initially, the emphasis will be on preventative care. In pregnant women who are Rh-negative and who risk having an Rh-positive baby, care will include monitoring, regular blood tests to check for antibodies, RhD immunoglobulin injections at 28 and/or 34 weeks gestation, as well as following a potentially blood-sensitizing event.
If antibodies are detected in the pregnant mother, the antibody titers will be closely monitored. If they increase to critical levels, this could indicate HDFN. Regular ultrasounds of the fetus will monitor for fetal anemia. If HDFN is confirmed, an intrauterine blood transfusion is the recommended treatment. This is a delicate intervention that involves injecting donor blood into the umbilical cord via an ultrasound-guided needle.
In addition, HDFN may lead to premature birth, often via a cesarean. Acute post-delivery care of mother and baby also requires the expertise of this specialized prenatal/neonatal team.
