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Feasibility of a non-invasive method to assess fetal hemolysis in utero during the third trimester

Journal of Perinatology volume 43, pages 1437–1439 (2023)Cite this article

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Hemolytic disease of the fetus and newborn (HDFN) occurs when the lifespan of fetal/neonatal red blood cells is significantly shortened, elevating bilirubin production and increasing the risk of anemia [1]. During a pregnancy where HDFN is known or suspected, fetal blood sampling by cordocentesis can be used to assess the presence of anemia and quantify its severity. However, such sampling carries procedure-related risks, thus non-invasive means of detecting fetal anemia have been evaluated. A useful method is middle cerebral artery (MCA) doppler peak systolic flow velocity [2]. Despite its utility, limitations are well known. These include false positive rates of 6 to 15%, particularly after 32–34 weeks gestation [2]. Additionally, cases of fetal hemolytic disease that are not severe enough to cause fetal anemia can, never-the-less, result in severe neonatal hyperbilirubinemia. On that basis, an MCA doppler reading is not always predictive of whether severe neonatal jaundice will be a problem [1, 2].

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Fig. 1: Schematic representation.

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Deidentified data will be shared on request to the corresponding author.

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Acknowledgements

We thank Sasikarn Pakdeeto MD, Neonatology, Mahidol University, Bangkok, Thailand for the original illustration and for reviewing the manuscript. We also thank Molly Adams, Intermountain Health Research, for assistance with the IRB review. We also thank Paul Vanasco MT(ASCP) and Terry Rees MT(ASCP)(SBB) of the Intermountain Health Transfusion Service for expert technical assistance. We also thank Robert L. Andres MD, Paul W. Whitecar MD, Douglas S. Richards MD, and Ibrahim A. Hammad, MD for referring patients for study.

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Authors and Affiliations

  1. Obstetric and Neonatal Operations, Intermountain Health, Murray, UT, USA

    Timothy M. Bahr & Robert D. Christensen

  2. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Timothy M. Bahr & Robert D. Christensen

  3. Student, University of Utah, Salt Lake City, UT, USA

    Thomas R. Christensen

  4. Student, University of Georgia, Athens, GA, USA

    Lillian S. Cheatham

  5. Division of Maternal-Fetal Medicine, Intermountain Health, Murray, Utah and Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA

    Jessica M. Page

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  1. Timothy M. Bahr
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  2. Thomas R. Christensen
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  3. Lillian S. Cheatham
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  4. Jessica M. Page
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  5. Robert D. Christensen
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Contributions

TMB, conception and design, assembly of data, data analysis, manuscript writing, final approval of the manuscript. TRC, collection of ETCOc samples from mothers and neonates, manuscript writing, and final approval of the manuscript. LSC, collection of ETCOc samples from mothers and neonates and final approval of the manuscript. JMP, manuscript writing, and final approval of the manuscript. RDC, conception and design, collection and assembly of data, data analysis and interpretation, original draft of the manuscript, writing, revising, and approving the last version of the manuscript.

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Correspondence to Timothy M. Bahr.

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Bahr, T.M., Christensen, T.R., Cheatham, L.S. et al. Feasibility of a non-invasive method to assess fetal hemolysis in utero during the third trimester. J Perinatol 43, 1437–1439 (2023). https://doi.org/10.1038/s41372-023-01764-8

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  • DOI: https://doi.org/10.1038/s41372-023-01764-8

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