ABSTRACT
Noninvasive fetal blood typing by cell-free DNA 68 Invasive monitoring of fetal anemia 68
Fetal blood typing 69 Amniocentesis for ΔOD450 69 Fetal blood sampling 70 Cordocentesis procedure 70
Preparing for IUT: Amniocentesis versus cordocentesis 71 Invasive treatment of fetal anemia 72
Goals of transfusion 72 Preoperative evaluation 72 Transfusion blood 72 Intravascular transfusion 72
Maternal operative preparation 72 Needle insertion 72 Transfusion volume 73 Needle removal 73 Complications 73
Intraperitoneal transfusion (IPT) 74 Preparation 75 Technique 75 IPT versus IVT 76
Fetal exchange transfusion 76 Intracardiac transfusion (ICT) 76 Noninvasive management of fetal alloimmune disease 76
Plasmapheresis 77 High-dose IVIG 77
Disorder-specic issues 77 Transplacental hemorrhage 77 Twin-to-twin transfusion syndrome 77 Parvovirus 78 Anemia at very early gestational age 78 Anemia beyond 32 weeks 78 Lethal fetal anemias 78 Class III/IV hydrops 78
Neonatal alloimmune thrombocytopenia 79 Posttransfusion monitoring 79 Outcome studies 79
Summary 80 References 80
Treatment of fetal anemia may be the most complete example of the concept of fetal therapy that has been achieved so far. Detecting the fetus at risk, evaluating the extent of disease, and delivery of transfusion blood by ultrasound-guided intrauterine transfusion (IUT), all continue to improve. The combination of maternal testing, ultrasound parameters, refinement of the application of fetal blood sampling, and mechanisms for reducing disease severity have all impacted the roles of IUT, with increased application, better safety, and better, more detailed results.
