Identification and management of fetal anaemia: a practical guide

Key content Fetal anaemia can be caused by alloimmune or infectious red cell destruction, disorders of fetal red cell production, fetal haemorrhage and as a complication of monochorionic multifetal pregnancy. A fetus at risk from maternal alloimmunisation can be detected by maternal serum screening for red cell antibodies and by fetal ultrasonography. Undiagnosed cases may present in routine obstetric practice, so awareness of the identification and initial management of fetal anaemia is important. Pregnancies must be triaged depending on clinical urgency, with input from fetal medicine specialists required. Developments in fetal ultrasound assessment and in fetal therapy have improved outcomes and contemporary research will focus on improving long term outcomes for neonatal survivors.Learning objectives To understand the varied aetiologies and pathophysiology of fetal anaemia and to adopt a system for reaching a diagnosis. To appreciate the different diagnostic tools available, comprising ultrasonography, microbiological testing, noninvasive and invasive tests in fetal medicine units and electronic fetal monitoring in the acute setting.Ethical issues Management involves balancing maternal and fetal risks. Research ethics should be considered in relation to experimental treatments and trials in fetal therapy.