To identify cases of hemolytic disease of the fetus and newborn (HDFN) early during pregnancy, a team of experts agree that prenatal testing for pregnancy risk factors such as ABO and Rhesus D incompatibility should ideally be performed between 11 and 14 weeks of gestation, according to a study recently published in the Journal of Obstetrics and Gynaecology Canada.
While some pregnant patients with HDFN experience only mild disease, others experience significantly adverse outcomes, including fetal death. It is thus of vital importance that cases of HDFN are identified as early as possible during pregnancies.
However, efforts to accelerate improvements in HDFN care are hampered by differing guidelines with divergent recommendations. A team of experts was thus assembled to arrive at a consensus on various aspects of HDFN care.
A total of 46 panelists from various disciplines, including a patient representative, took part in this process, which involved three rounds of voting on various stages of HDFN care, encompassing both testing and treatment. The result of these careful deliberations was the establishment of 21 consensus statements on best practices in the management of HDFN.
Read more about HDFN testing and diagnosis
With regards to antenatal care, experts agree that prenatal screening for antibodies associated with HDFN should ideally be conducted between 11 and 14 weeks of gestation. In pregnancies that test negative, there is little value in repeating an antibody test at 28 weeks of gestation.
For pregnant women who are Rhesus negative, the expert panel recommends that routine antenatal Rhesus immunoglobulin be administered at approximately 28 weeks of gestation. Rhesus immunoglobulin is also recommended within the 72 hours following the delivery of a Rhesus-positive newborn resulting from a Rhesus-negative pregnancy (ie, a pregnancy affected by HDFN secondary to Rhesus incompatibility).
With regards to fetal maternal hemorrhage, experts recommend that fetal maternal hemorrhage testing be performed from 20 weeks of gestation for pregnancies with a sensitizing event (ie, an event in which fetal blood cells enter the maternal circulation, provoking the mother’s immune system to develop antibodies against fetal red blood cells) as this may increase the risk of fetal maternal hemorrhage.
“These 21 expert consensus statements for testing and [Rhesus immunoglobulin] administration in pregnancies represent a concerted Canadian effort to standardize care in an area where guidelines sometimes conflict,” the authors of the study concluded. “Although some statements may represent a change in practice, they aim to provide high-quality, patient-centred care.”
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