Treatment of affected fetusbefore delivery

Treatment depends on past obstetric history, the nature and titre of the antibody and paternal expression of the antigen. The fetal genotype can be established by CVS, fetal blood sampling and PCR.

Examination of the amniotic fluid to assess the degree of hyperbilirubinaemia is indicated with a poor past history (exchange transfusion or stillbirth in previous baby) and high titre (1:8-1:64) of an antibody likely to cause severe HDN (e.g. anti-D, anti-c or anti-Kell). The amniotic fluid bilirubin at optical density 450nm dictates treatment according to the Liley chart (opposite), which estimates the blood concentration.

Options include intrauterine transfusion (IUT) if fetus is not deemed mature enough for delivery (check lung maturity on phospholipid levels) or induction of labour if it is. Intensive maternal plasmapheresis may be useful to reduce antibody titre. Advances in management of very premature babies are such that nowadays IUT rarely performed.

0 0

Post a comment