Therapeutic management of fetal anemia: review of standard practice and alternative treatment options

Abstract

Fetal anemia, mainly due to red cell alloimmunization, is still a significant cause of fetal and neonatal mortality and morbidity. The focus of current clinical research has shifted from an invasive approach to non-invasive management and treatment of affected pregnancies, and the progress in this field is associated with a major improvement in perinatal outcome. During the last 50 years, intrauterine red cells transfusion (IUT), first via the intraperitoneal route and later directly to fetal circulation, is the standard practice in most centers, with survival rates that exceed 90%, particularly if anemia is diagnosed early and treated in a timely manner. In addition, plasmapheresis and intravenous administration of high-dose immunoglobulin have been implicated in the treatment of pregnancies complicated with early-onset severe red cell alloimmunization, alone or in combination with IUTs before the 20^th week of pregnancy, but there are still issues to be clarified further. This review article aims to provide an overview of the current standard therapeutic management and alternative treatment modalities in pregnancies complicated by fetal anemia.