Additional reading by topic.

On this page you will find additional information about all of the topics covered on the Allo Hope Foundation's website. These resources are intended to assist you in your search for more in-depth information about a particular topic. This page is updated with new links, so check back often.

Antibody screening and titers

Management of pregnancy complicated by RhD alloimmunization Author: Kenneth J Moise Jr, MD

Management of non-RhD red blood cell alloantibodies during pregnancy. Authors: Kenneth J Moise Jr, MD, Melanie S Kennedy, MD

AABB

Comparison of total and IgG ABO antibody titers in healthy individuals by using tube and column agglutination techniques. Ann Lab Med. 2014;34(3):223‐229. doi:10.3343/alm.2014.34.3.223

Comparison of antibody titers using conventional tube technique versus column agglutination technique in ABO blood group incompatible renal transplant. Asian J Transfus Sci. 2017;11(2):131‐134. doi:10.4103/0973-6247.214343


Indirect Agglutination Test (IAT) Exceptions

These antibodies have a negative IAT on the mother, but still have an affected fetus/neonate: anti-Jsa, anti-Dia, and anti-Wra. Since anti-Dia and anti-Wra are both in the Diego blood group, it leads to speculation if anti-Dib could produce the same result.

The first case of hydrops from anti-Jsa was reported in 2005. What is startling to note about this was that the mother's Indirect Coombs test was NEGATIVE despite the infant having hydrops and a positive Direct Coombs (strength of 3+). The woman had lost an infant before due to hydrops, the cause of which was never identified. Further testing revealed the woman to be Jsa- and the baby Jsa+. Both maternal and fetal blood reacted with Jsa+ cells and they were able to identify the antibody as anti-Jsa. Delayed onset anemia was found on day 14 and the infant was treated with a transfusion, phototherapy and erythropoietin. The first case of hydrops fetalis caused by anti-Jsa. A case report and suggestions on the antenatal diagnosis of haemolysis due to antibodies against rare antigens. Blood Transfusion 2005; 3: 76-83

Hémolytique du nouveau-né par anticorps anti-Diegoa (anti-Dia) [Hemolytic disease of newborn infants caused by anti-Diego antibodies]. Arch Fr Pediatr. 1984;41(9):641‐643.

Characterization of an anti-Dia antibody causing hemolytic disease in a newborn infant. Transfusion. 1982;22(3):246‐247. doi:10.1046/j.1537-2995.1982.22382224952.x

Un cas de maladie hémolytique du nouveau-né par anticorps anti-Wra (WRIGHT) [A case of hemolytic disease in a newborn associated with anti-Wra (WRIGHT) antibodies]. Rev Fr Transfus Immunohematol. 1984;27(2):271‐275.

Hémolytique néonatale modérê due à un anticorps anti-Wr(a) [Clinical case of the month. Mild hemolytic disease of the newborn due to an anti-Wr(a) antibody]. Rev Med Liege. 2012;67(7-8):403‐406.

Blood Transfusion

Autologous Blood Donation and Transfusion

Serial blood donations for intrauterine transfusions of severe hemolytic disease of the newborn with the use of recombinant erythropoietin in a pregnant woman alloimmunized with anti-Ku. Transfusion. 2005;45(11):1791‐1795. doi:10.1111/j.1537-2995.2005.00604.x

Successful management of severe hemolytic disease of the fetus due to anti-Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature. Transfusion. 2014;54(1):238‐243. doi:10.1111/trf.12331

Hemolytic disease of the newborn associated with anti-Jra alloimmunization in a twin pregnancy: the first case report in Korea. Korean J Lab Med. 2010;30(5):511‐515. doi:10.3343/kjlm.2010.30.5.511

Braschler T, Vökt CA, Hustinx H, et al. Management of a pregnant woman with anti-holley alloantibody. Transfus Med Hemother. 2015;42(2):129‐130. doi:10.1159/000371499


Intrauterine Transfusion

Intrauterine Fetal Transfusion of Red Blood Cells. Up to Date.

Religious objections to blood products

Information about blood products and religious recommendations for patients facing alloimmunization and HDFN. The Allo Hope Foundation does not recommend these treatments, however we do recognize that for a few patients, blood products are not an option. These case reports of experimental treatments are not aligned with current standards of care and should only be used as an absolute last resort for those who cannot receive blood products.

Kappas A, Drummond GS, Munson DP, Marshall JR. Sn-Mesoporphyrin interdiction of severe hyperbilirubinemia in Jehovah's Witness newborns as an alternative to exchange transfusion. Pediatrics. 2001;108(6):1374‐1377. doi:10.1542/peds.108.6.1374

Lakatos L. Bloodless treatment of infants with haemolytic disease. Arch Dis Child. 2004;89(11):1076. doi:10.1136/adc.2004.053215

Lakatos L, Csáthy L, Nemes E. "Bloodless" treatment of a Jehovah's Witness infant with ABO hemolytic disease. J Perinatol. 1999;19(7):530‐532. doi:10.1038/sj.jp.7200223

Cord blood testing

Haemolytic Disease of the Newborn. Arch Dis Child Fetal Neonatal Ed. 2007 Mar; 92(2): F83–F88. doi: 10.1136/adc.2005.076794

Postnatal diagnosis and management of hemolytic disease of the fetus and newborn. Accessed July 11, 2018


Direct Agglutination Test (DAT) Exceptions

Anti-C, anti-c, anti-Fya, anti-Good, anti-H, anti-Jra, anti-M, and anti-Mta are the DAT Exceptions. The test may show negative, but the infant is still severely affected.

Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test. Journal of Transfusion Medicine. 1995 Jun;5(2):113-6. Doi: 10.1111/j.1365-3148.1995.tb00197

Haemolytic disease of the newborn caused by anti-c, anti-E and anti-Fya antibodies: report of five cases. Prenatal Diagnosis. 1999; 19(6):533-536. Doi: 10.1002/(SICI)1097-0223(199906)19:6%3C533

The Good Factor as a Possible Cause of Hemolytic Disease of the Newborn. The Blood Journal. ​

A rare case of haemolytic disease of the newborn with Bombay phenotype mother. The Asian Journal of Transfusion Science. 2013; 7(2): 153-155. doi: ​ 10.4103/0973-6247.115583

Suspected anemia caused by maternal anti-Jra antibodies: a case report. Biomark Research. 2015; 3:23. Doi: 10.1186/s40364-015-0048-x

Anti-M Antibody in Pregnancy. Obstet Gynecol Surv. 1989; 44(9):637-641

Severe Hemolytic Disease of the Newborn Caused by Anti-M Antibodies. The Iranian Journal of Pediatrics. 2013. 23(5): 607-608.

Maternal anti-M induced hemolytic disease of the newborn followed by prolonged anemia in newborn twins. The Asian Journal of Transfusion Science. 2015 9(1):98-101

Anti-Mta associated with three cases of hemolytic disease of the newborn. Immunohematology. 2002;18(2):37-9.

Postnatal diagnosis and management of hemolytic disease of the fetus and newborn. Up to Date.

Hemolytic Disease of the Newborn Workup. Medscape.

Erythropoietin

Management of late anemia in Rhesus hemolytic disease: use of recombinant human erythropoietin (a pilot study). Pediatr Res. 1996 May; 39(5): 831–834. doi: 10.1203/00006450-199605000-00015

Hyporegenerative anemia and other complications of rhesus hemolytic disease: to treat or not to treat is the question. Pan Afr Med J. 2019;32:120. Published 2019 Mar 14. doi:10.11604/pamj.2019.32.120.17757

Hemolytic disease of the fetus and newborn with late-onset anemia due to anti-M: a case report and review of the Japanese literature. Transfus Med Rev. 2014;28(1):1‐6. doi:10.1016/j.tmrv.2013.10.002

Use of recombinant erythropoietin for the management of severe hemolytic disease of the newborn of a K0 phenotype mother. Pediatr Hematol Oncol. 2007;24(1):69‐73. doi:10.1080/08880010601001453

Tratamiento de la anemia hiporregenerativa tardía de la enfermedad hemolítica del recién nacido con eritropoyetina recombinante [Recombinant erythropoietin as treatment for hyporegenerative anemia following hemolytic disease of the newborn]. Arch Argent Pediatr. 2009;107(2):119‐125. doi:10.1590/S0325-00752009000200005

Tratamiento con eritropoyetina para la anemia tardía tras enfermedad hemolítica del recién nacido [Erythropoietin treatment for late anaemia after haemolytic disease of the newborn]. An Pediatr (Barc). 2010;73(6):334‐339. doi:10.1016/j.anpedi.2010.09.002

“Bloodless” Treatment of a Jehovah’s Witness Infant With ABO Hemolytic Disease. J Perinatol 19, 530–532 (1999). https://doi.org/10.1038/sj.jp.7200223

Anti-Rh(c), "little c," isoimmunization: the role of rHuEpo in preventing late anemia. J Pediatr Hematol Oncol. 2013;35(6):e269‐e271. doi:10.1097/MPH.0b013e318271f5b0

Hyporegenerative anemia and other complications of rhesus hemolytic disease: to treat or not to treat is the question. Pan Afr Med J. 2019;32:120. Published 2019 Mar 14. doi:10.11604/pamj.2019.32.120.17757

Hyperbilirubinemia

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004 Oct;114(4):1138]. Pediatrics. 2004;114(1):297‐316. doi:10.1542/peds.114.1.297

Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med. 2004;16(3):163‐166. doi:10.1080/14767050400009873

Kappas A, Drummond GS, Munson DP, Marshall JR. Sn-Mesoporphyrin interdiction of severe hyperbilirubinemia in Jehovah's Witness newborns as an alternative to exchange transfusion. Pediatrics. 2001;108(6):1374‐1377. doi:10.1542/peds.108.6.1374


Bronze Baby Syndrome

Bronze Baby Syndrome. Journal of Pediatrics. 2017; 188:301. doi:10.1016/j.jpeds.2017.05.005

Bronze Baby Syndrome and the Risk of Kernicterus. Acta Paediatr. 2005;94(7):968‐971. doi:10.1111/j.1651-2227.2005.tb02020.x


Exchange Transfusion

Neonatal Top-Up Transfusions in Alloimmune Hemolytic Disease of the Newborn: Incidence and Risk Factors. Am J Perinatol 2018; 35(S 01): S1-S26 DOI: 10.1055/s-0038-1647096

Jurfest-Ceccon ME, de Albuquerque Diniz EM, de Araujo-Ramos JL, Costa-Vaz FA. Efectos bioquímicos y hematimétricos de la exanguinotransfusión en el recién nacido con isoinmunización [Biochemical and hematometric effects of exchange transfusion in isoimmunized neonates]. Bol Med Hosp Infant Mex. 1993;50(3):167‐176.

University of Iowa Stead Family Children's Hospital. Iowa Neonatology Handbook - Exchange Transfusion.

Kappas A, Drummond GS, Munson DP, Marshall JR. Sn-Mesoporphyrin interdiction of severe hyperbilirubinemia in Jehovah's Witness newborns as an alternative to exchange transfusion. Pediatrics. 2001;108(6):1374‐1377. doi:10.1542/peds.108.6.1374


IVIG - Infant

Hemolytic anemia caused by non-D minor blood incompatibilities in a newborn. Pan Afr Med J. 2019;33:262. Published 2019 Jul 29. doi:10.11604/pamj.2019.33.262.19324

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004 Oct;114(4):1138]. Pediatrics. 2004;114(1):297‐316. doi:10.1542/peds.114.1.297

Intravenous Immunoglobulin (IVIG). About Kids Health

Cortey A, Elzaabi M, Waegemans T, Roch B, Aujard Y. [Efficacy and safety of intravenous immunoglobulins in the management of neonatal hyperbilirubinemia due to ABO incompatibility: a meta-analysis]. Archives de Pediatrie : Organe Officiel de la Societe Francaise de Pediatrie. 2014 Sep;21(9):976-983. DOI: 10.1016/j.arcped.2014.02.005.

hMiqdad AM, Abdelbasit OB, Shaheed MM, Seidahmed MZ, Abomelha AM, Arcala OP. Intravenous immunoglobulin G (IVIG) therapy for significant hyperbilirubinemia in ABO hemolytic disease of the newborn. J Matern Fetal Neonatal Med. 2004;16(3):163‐166. doi:10.1080/14767050400009873

Mundy CA. Intravenous immunoglobulin in the management of hemolytic disease of the newborn. Neonatal Netw. 2005;24(6):17‐24. doi:10.1891/0730-0832.24.6.17


Kernicterus

Smitherman H, Stark AR, Bhutani VK. Early recognition of neonatal hyperbilirubinemia and its emergent management. Semin Fetal Neonatal Med. 2006;11(3):214‐224. doi:10.1016/j.siny.2006.02.0029

Kernicterus Center of Excellence

KernicterusMedscape.

Parents of Infants and Children with Kernicterus


Phototherapy

Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004 Oct;114(4):1138]. Pediatrics. 2004;114(1):297‐316. doi:10.1542/peds.114.1.297

de Haas M, Thurik FF, Koelewijn JM, van der Schoot CE. Haemolytic disease of the fetus and newborn. Vox Sang. 2015;109(2):99‐113. doi:10.1111/vox.12265

Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358(9):920‐928. doi:10.1056/NEJMct0708376

Iron Status

Nasrat HA, Nicolini U, Nicolaidis P, Letsky EA, Gau G, Rodeck CH. The effect of intrauterine intravascular blood transfusion on iron metabolism in fetuses with Rh alloimmunization. Obstet Gynecol. 1991;77(4):558‐562.

Yalaz M, Bilgin BS, Köroğlu OA, et al. Desferrioxamine treatment of iron overload secondary to RH isoimmunization and intrauterine transfusion in a newborn infant. Eur J Pediatr. 2011;170(11):1457‐1460. doi:10.1007/s00431-011-1521-7

Sreenan C, Idikio HA, Osiovich H. Successful chelation therapy in a case of neonatal iron overload following intravascular intrauterine transfusion. J Perinatol. 2000;20(8 Pt 1):509‐512. doi:10.1038/sj.jp.7200458

Lasker MR, Eddleman K, Toor AH. Neonatal hepatitis and excessive hepatic iron deposition following intrauterine blood transfusion. Am J Perinatol. 1995;12(1):14‐17. doi:10.1055/s-2007-994390

Khdair-Ahmad F, Aladily T, Khdair-Ahmad O, Badran EF. Chelation therapy for secondary neonatal iron over load: Lessons learned from rhesus hemolytic disease. Turk J Pediatr. 2018;60(3):335‐339. doi:10.24953/turkjped.2018.03.018

"On the contrary, iron overload occurs in 70% of neonates with alloimmune HDFN at birth, 50% at the age of 1 month and 18% at the age of 3 months. Therefore, we advise to measure iron status, and we discourage the use of iron supplementation in the first 3 months of life in neonates with alloimmune HDFN. Haemolysis and intrauterine and postnatal transfusions probably both contribute to the high incidence of iron overload in alloimmune HDFN."

70% of iso babies had iron overload at birth, none were iron deficient at birth, 50% at 1 month had iron overload, and 18% had iron overload at 3 months. "There is a number of case reports published on the risk of severe iron overload, diagnosed by liver biopsies, following IUTs for Rh HDFN. These infants were all born at 33 or 34 weeks of gestation and received 2–5 IUTs and several postnatal transfusions. Their serum ferritin levels ranged from 2479 to 28 800 lg/l. In addition to transfusions for alloimmune HDFN, the haemolysis itself can also contribute to iron overload in alloimmune HDFN." This article also talks about IUTs as a risk factor for choleostasis. Rath ME, Smits-Wintjens VE, Oepkes D, Walther FJ, Lopriore E. Iron status in infants with alloimmune haemolytic disease in the first three months of life. Vox Sang. 2013;105(4):328‐333. doi:10.1111/vox.12061

"As discussed above, neonates with RHDN often require IUTs and (multiple) transfusions of red blood cells. The risks and potential consequences of iron overload due to these multiple transfusions are poorly recognized. High levels of cord blood ferritine have been reported in infants with RHDN.57 As infants with RHDN already have high iron storage, supplementation of iron is not recommended and should not be used." Smits-Wintjens VE, Walther FJ, Lopriore E. Rhesus haemolytic disease of the newborn: Postnatal management, associated morbidity and long-term outcome. Semin Fetal Neonatal Med. 2008;13(4):265‐271. doi:10.1016/j.siny.2008.02.005

"A 34 weeks' gestation baby with RHD, who had received multiple intrauterine transfusions (IUT), developed cholestatic hepatic disease and secondary hemophagocytic lymphohistiocytosis (HLH). Her serum ferritin level increased to 5527 ng/mL, and liver biopsy showed severe iron overload. We suggest that patients who have undergone IUT be evaluated for hyperferritinemia." Yilmaz S, Duman N, Ozer E, et al. A case of rhesus hemolytic disease with hemophagocytosis and severe iron overload due to multiple transfusions. J Pediatr Hematol Oncol. 2006;28(5):290‐292. doi:10.1097/01.mph.0000212906.07018.93

"Iron therapy is contraindicated in most cases of hemolytic anemia. The reason is that iron released from RBCs in most hemolytic anemias is reused and iron stores are not reduced. " Hemolytic Anemia Treatment & Management Medscape

“The vast majority of neonates with alloimmune HDFN have iron overload at birth. Incidence of iron overload gradually decreases within the first 3 months without iron supplementation...In recent literature, a ferritin level <12 lg/l is used for the definition of iron deficiency during the first year of life. Based on that definition, no cases of iron deficiency were present until 3 months of age in our study group... On the contrary, iron overload occurs in 70% of neonates with alloimmune HDFN at birth, 50% at the age of 1 month and 18% at the age of 3 months. Therefore, we advise to measure iron status, and we discourage the use of iron supplementation in the first 3 months of life in neonates with alloimmune HDFN.” Iron status in infants with alloimmune haemolytic disease in the first three months of life. Vox Sang. 2013 Nov;105(4):32833. doi: 10.1111/vox.12061.

Rhesus haemolytic disease of the newborn: Postnatal management, associated morbidity and long-term outcome. Semin Fetal Neonatal Med. 2008 Aug;13(4):265-71. doi: 10.1016/j.siny.2008.02.005.

A Case of Rhesus Hemolytic Disease With Hemophagocytosis and Severe Iron Overload Due to Multiple Transfusions. The Journal of Pediatric Hematology and Oncology. 2006 May;28(5):290-2. DOI: 10.1097/01.mph.0000212906.07018.93

Hemolytic Disease of the Fetus and Newborn: Managing the Mother, Fetus, and Newborn. Hematology Am Soc Hematol Educ Program. 2015;2015:146-51. doi: 10.1182/asheducation-2015.1.146.


Chelation Therapy

Successful chelation therapy in a case of neonatal iron overload following intravascular intrauterine transfusion. J Perinatol. 2000;20(8 Pt 1):509‐512. doi:10.1038/sj.jp.7200458

Desferrioxamine treatment of iron overload secondary to RH isoimmunization and intrauterine transfusion in a newborn infant. Eur J Pediatr. 2011;170(11):1457‐1460. doi:10.1007/s00431-011-1521-7

IVIG - Maternal

Nwogu LC, Moise KJ Jr, Klein KL, Tint H, Castillo B, Bai Y. Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion. Transfusion. 2018;58(3):677‐684. doi:10.1111/trf.14453

Zwiers C, van Kamp I, Oepkes D, Lopriore E. Intrauterine transfusion and non-invasive treatment options for hemolytic disease of the fetus and newborn - review on current management and outcome. Expert Rev Hematol. 2017;10(4):337‐344. doi:10.1080/17474086.2017.1305265

Mayer B, Hinkson L, Hillebrand W, Henrich W, Salama A. Efficacy of Antenatal Intravenous Immunoglobulin Treatment in Pregnancies at High Risk due to Alloimmunization to Red Blood Cells. Transfus Med Hemother. 2018;45(6):429‐436. doi:10.1159/000490154

Sacher RA, King JC. Intravenous gamma-globulin in pregnancy: a review. Obstet Gynecol Surv. 1989;44:25–34. Epub 1989/01/01.

de la Cámara C, Arrieta R, González A, Iglesias E, Omeñaca F. High-dose intravenous immunoglobulin as the sole prenatal treatment for severe Rh immunization. N Engl J Med. 1988;318(8):519‐520. doi:10.1056/NEJM198802253180816


IVIG with Plasmpaheresis

Nwogu LC, Moise KJ Jr, Klein KL, Tint H, Castillo B, Bai Y. Successful management of severe red blood cell alloimmunization in pregnancy with a combination of therapeutic plasma exchange, intravenous immune globulin, and intrauterine transfusion. Transfusion. 2018;58(3):677‐684. doi:10.1111/trf.14453

Zwiers C, van der Bom JG, van Kamp IL, et al. Postponing Early intrauterine Transfusion with Intravenous immunoglobulin Treatment; the PETIT study on severe hemolytic disease of the fetus and newborn. Am J Obstet Gynecol. 2018;219(3):291.e1‐291.e9. doi:10.1016/j.ajog.2018.06.007

Bellone M, Boctor FN. Therapeutic plasma exchange and intravenous immunoglobulin as primary therapy for D alloimmunization in pregnancy precludes the need for intrauterine transfusion. Transfusion. 2014;54(8):2118‐2121. doi:10.1111/trf.12633

Fox C, Martin W, Somerset DA, Thompson PJ, Kilby MD. Early intraperitoneal transfusion and adjuvant maternal immunoglobulin therapy in the treatment of severe red cell alloimmunization prior to fetal intravascular transfusion. Fetal Diagn Ther. 2008;23(2):159‐163. doi:10.1159/000111599

Tara F, Maleki A, Taheri N, Moein Darbari S. A case of D alloimmunization in pregnancy: successfully treated solely with therapeutic plasma exchange (TPE). J Blood Med. 2019;10:251-253. https://doi.org/10.2147/JBM.S204128

Marson P, Gervasi MT, Tison T, et al. Therapeutic apheresis in pregnancy: general considerations and current practice. Transfusion Apheresis Science. 2015;53:256–261. Epub 2015/12/02.

Ruma MS, Moise KJ Jr., Kim E, et al. Combined plasmapheresis and intravenous immune globulin for the treatment of severe maternal red cell alloimmunization. Am J Obstet Gynecol. 2007;196:138.e1-6. Epub 2007/02/20.

MCA scans

Opheim GL, Zucknick M, Henriksen T, Haugen G. A maternal meal affects clinical Doppler parameters in the fetal middle cerebral artery. PLoS One. 2018;13(12):e0209990. Published 2018 Dec 31. doi:10.1371/journal.pone.0209990

Steroids

Steroids can falsely lower the MoM score, enough to make doctors think the baby is not anemic and does not need a transfusion. This is not the case. Steroids do not treat anemia, and if the baby was anemic before the steroids, the baby will still be anemic after the steroids. Below are some articles that talk about steroids falsely lowering the MoM scores. Also, Progesterone (oral or as a shot like Makena) can lower the PSV on the MCA scan as well (see the last article listed).

Urban R, Lemancewicz A, Przepieść J, Urban J, Kretowska M. Antenatal corticosteroid therapy: a comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms. Eur J Obstet Gynecol Reprod Biol. 2005;120(2):170‐174. doi:10.1016/j.ejogrb.2004.09.009 Conclusion: Our results indicate significant decrease in fetal middle cerebral artery impedance at 72 h after maternal administration of the first dose of dexamethasone.

Piazze JJ, Anceschi MM, La Torre R, Amici F, Maranghi L, Cosmi EV. Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry. Early Hum Dev. 2001;60(3):225‐232. doi:10.1016/s0378-3782(00)00120-1 Conclusion: Betamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages <32 weeks'.

Piazze J, Anceschi MM, Cerekja A, et al. The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies. J Perinat Med. 2007;35(2):135‐140. doi:10.1515/JPM.2007.027 Conclusion: In low risk pregnancies, betamethasone therapy in the third trimester is related to a significant but transient reduction of MCA PI, which is more pronounced during tocolytic therapy. Although the physiological basis of this effect is currently unclear, it could be related to the local regulation of intracerebral blood flow.

Rotmensch S, Liberati M, Vishne TH, Celentano C, Ben-Rafael Z, Bellati U. The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial. Acta Obstet Gynecol Scand. 1999;78(6):493‐500. Conclusions: Both betamethasone and dexamethasone induce a profound, albeit transient, suppression of fetal heart rate characteristics and biophysical activities in the preterm fetus. However, the effect of betamethasone is more pronounced. Awareness of these phenomena might prevent unwarranted iatrogenic delivery of preterm fetuses.

Müller T, Nanan R, Dietl J. Effect of antenatal corticosteroid administration on Doppler flow velocity parameters in pregnancies with absent or reverse end-diastolic flow in the umbilical artery. Acta Obstet Gynecol Scand. 2003;82(9):794‐796.

Henry A, Shand A, Welsh A. The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Australas J Ultrasound Med. 2013;16(3):135‐141. doi:10.1002/j.2205-0140.2013.tb00101.x

Chitrit Y, Caubel P, Herrero R, Schwinte AL, Guillaumin D, Boulanger MC. Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms. BJOG. 2000;107(4):501‐507. doi:10.1111/j.1471-0528.2000.tb13269.x Conclusions: The current study finds in healthy fetuses a transient, significant and unexplained decrease in fetal middle cerebral artery impedance on the fourth day following maternal dexamethasone administration. Further basic research and clinical studies including larger sample sizes or pregnancies with fetoplacental dysfunction are needed.

Edwards A, Baker LS, Wallace EM. Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone. Ultrasound Obstet Gynecol. 2002;20(3):240‐244. doi:10.1046/j.1469-0705.2002.00782.x. Recorded a decrease in MoM at 24 hours.

Azza A.Abd El Hameed. Vaginal versus intramuscular progesterone in the prevention of preterm labor and their effect on uterine and fetal blood flow. Middle East Fertility Society Journal. 2012;17 (3):163-169. doi.org/10.1016/j.mefs.2011.12.003 A statistically significant decrease in fetal MCA-PI was noted after progesterone administration both vaginally and IM.

Urban R, Lemancewicz A, Przepieść J, Urban J, Kretowska M. Antenatal corticosteroid therapy: a comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms. Eur J Obstet Gynecol Reprod Biol. 2005;120(2):170‐174. doi:10.1016/j.ejogrb.2004.09.009

Piazze JJ, Anceschi MM, La Torre R, Amici F, Maranghi L, Cosmi EV. Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry. Early Hum Dev. 2001;60(3):225‐232. doi:10.1016/s0378-3782(00)00120-1

Henry A, Shand A, Welsh A. The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Australas J Ultrasound Med. 2013;16(3):135‐141. doi:10.1002/j.2205-0140.2013.tb00101.x

Chitrit Y, Caubel P, Herrero R, Schwinte AL, Guillaumin D, Boulanger MC. Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms. BJOG. 2000;107(4):501‐507. doi:10.1111/j.1471-0528.2000.tb13269.x