*The Allo Hope Foundation does not endorse any medical or professional service obtained through information provided on this site or any links to this site. While our web site content is frequently updated, medical information changes rapidly and therefore, some information may be out of date, and/or contain inaccuracies.

Additional Reading by Topic



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

Autologous Blood Donation

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

 

Blood Transfusion

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

 

Cell-free fetal DNA

Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunized pregnant women: evaluation of a 7-year clinical experience by PG Scheffer, a,b CE van der Schoot, b GCML Page-Christiaens, a M de Haas b,c.

Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy. By Gutensohn K et al.

Prenatal non-invasive foetal RHD genotyping: diagnostic accuracy of a test as a guide for appropriate administration of antenatal anti-D immunoprophylaxis. By Manfroi S et al 

USA Sensigene RhD test

Australian Red Cross Non-Invasive Prenatal Analysis (NIPA) for RhD

Netherlands Sanquin website – tests for c, C, D, e, E, K, and k.

UK testing for those in the NHS system – click on “Fetal RhD Sampling” for anti-D, and click on “Molecular Diagnostics” and “Fetal Genotype Sample Referral Form”.

Canadian Blood Service – Fetal genotyping from maternal plasma

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

 

Cholestasis

Cholestasis in a neonate with ABO haemolytic disease of newborn following transfusion of ABO group-specific red cells compatible with neonatal serum: inspissated bile syndrome. Blood Transfus. 2014;12(4):621‐623. doi:10.2450/2014.0099-14

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

Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol. 2017;10(7):607‐616. doi:10.1080/17474086.2017.1331124

Cholestasis in neonates with red cell alloimmune hemolytic disease: incidence, risk factors and outcome. Neonatology. 2012;101(4):306‐310. doi:10.1159/000335333

Severe Fetal Hemolysis and Cholestasis Due to High-Titer Maternal IgG Anti-A Antibodies. Pediatrics. 2019;143(4):e20182859. doi:10.1542/peds.2018-2859

 

Chorioamnionitis

 

Clinical Trials

www.allohopefoundation.org/trials

 

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

 

Delayed Onset Anemia and Hyporegenerative Anemia

Severe late anemia of hemolytic disease of the newborn. Paediatr Child Health. 1999;4(3):201‐203. doi:10.1093/pch/4.3.201

Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol. 2017;10(7):607‐616. doi:10.1080/17474086.2017.1331124

Hemolytic Anemia. Medscape.

https://medlineplus.gov/anemia.html

https://kidshealth.org/en/parents/anemia-hemolytic.html

 

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

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

University of Iowa Stead Family Children’s Hospital. Iowa Neonatology Handbook – Exchange Transfusion.

 

Hemolytic Anemia and Iron Status

“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.

Late Onset Severe Anemia Due to Rhesus Isoimmunization. International Journal of Contemporary Pediatrics. 2016; 3(4), 1472-1473. DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20163704

Hemolytic Anemia Treatment & Management. Medscape.

 

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

 

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.

 

Intrauterine Transfusion

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

Iron

https://www.ncbi.nlm.nih.gov/pubmed/1900601

https://www.ncbi.nlm.nih.gov/pubmed/21735053

https://www.ncbi.nlm.nih.gov/pubmed/11190591

https://www.ncbi.nlm.nih.gov/pubmed/7710568

https://www.ncbi.nlm.nih.gov/pubmed/30511551

Iron status in infants with alloimmune haemolytic disease in the first three months of life E. A. Rath,1 V. E. H. J. Smits-Wintjens,1 D. Oepkes,2 F. J. Walther1 & E. Lopriore1

“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. https://www.ncbi.nlm.nih.gov/pubmed/23802744

Rhesus hemolytic disease of the newborn: postnatal management, associated morbidity and long-term outcome Vivianne EHJ Smits-Wintjens Frans J Walther Enrico Lopriore. “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.” https://www.ncbi.nlm.nih.gov/pubmed/18387863

A Case of Rhesus Hemolytic Disease With Hemophagocytosis and Severe Iron Overload Due to Multiple Transfusions Ylmaz, Şebnem MD*ı; Duman, Nuray MD†; Özer, Esra MD†; Kavas, Nazan MD‡; Ören, Hale MD*; Demircioğlu, Fatih MD*; Kumral, Abdullah MD*; Özkan, Hasan MD†; İrken, Gülersu MD*; Özer, Erdener MD “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.” http://mobile.journals.lww.com/jpho-online/Abstract/2006/05000/A_Case_of_Rhesus_Hemolytic_Disease_With.3.aspx

Hemolytic Anemia Treatment & Management Paul Schick, MD ” 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. ” http://emedicine.medscape.com/article/201066-treatment#showall

 

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

https://pediatrics.aappublications.org/content/114/1/297

http://www.aboutkidshealth.ca/En/HealthAZ/Drugs/Pages/Intravenous-Immunoglobulin-IVIG.aspx

https://europepmc.org/article/med/25125032

https://www.tandfonline.com/doi/abs/10.1080/jmf.16.3.163.166

https://pubmed.ncbi.nlm.nih.gov/16383181/

 

IVIG – Maternal (see also “Plasmapheresis with IVIG”)

https://pubmed.ncbi.nlm.nih.gov/29250791/

 

Kernicterus

http://pick-k.org

http://emedicine.medscape.com/article/975276-followup#showall

http://www.childrensmercy.org/kernicterus/

https://www.sciencedirect.com/science/article/pii/S1744165X06000199

 

Long Term Outcomes

https://www.ncbi.nlm.nih.gov/pubmed/22030316

https://www.ncbi.nlm.nih.gov/pubmed/18387863

http://dx.doi.org/10.1136/archdischild-2016-310984

https://adc.bmj.com/cgi/rapidpdf/archdischild-2016-310984

https://pubmed.ncbi.nlm.nih.gov/29476829/

 

Neutropenia 

Delaney M, Matthews DC. 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.

Boxer L. Isoimmune Neonatal Neutropenia. The Journal of Pediatrics. J Pediatr. 1972; 5:775-782. doi:10.1016/S0022-3476(72)80131-8

LALEZARI, P., NUSSBAUM, M., GELMAN, S., & SPAET, T. H. Neonatal Neutropenia Due to Maternal Isoimmunization. Blood 1960: 15(2), 236-243. http://www.bloodjournal.org/content/15/2/236.  Accessed August 06, 2018.

Bux, J., Jung, K.D., Kauth, T. & Mueller-Eckhardt, C. Serological and clinical aspects of granulocyte antibodies leading to alloimmune neonatal neutropenia. Transfusion Med 1992; 2:143149. doi:10.1111/j.1365-3148.1992.tb00148.x

Koenig JM, Christensen RD. Neutropenia and thrombocytopenia in infants with Rh hemolytic disease. Journal of Pediatrics. J Pediatr. 1989 Apr;114(4 Pt 1):625-31. doi:10.1016/S00223476(89)80709-7.

https://www.nlm.nih.gov/medlineplus/ency/article/007230.htm

http://www.ncbi.nlm.nih.gov/pubmed/3718645

https://www.blutspendedienst-west.de/ueber_uns/zentren_einrichtungen/leukozytenimmunologie_eng/nin.php

https://www.karger.com/Article/Abstract/343261

Phototherapy

https://pediatrics.aappublications.org/content/114/1/297

https://onlinelibrary.wiley.com/doi/full/10.1111/vox.12265

https://www.nejm.org/doi/full/10.1056/nejmct0708376

 

Plasmapheresis with IVIG

https://www.sciencedirect.com/science/article/pii/S0002937818304940

https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.12633

https://www.karger.com/Article/Abstract/111599

https://www.dovepress.com/a-case-of-d-alloimmunization-in-pregnancy-successfully-treated-solely–peer-reviewed-article-JBM

http://www.healthline.com/health/plasmapheresis#Effects2

Sacher RA, King JC. Intravenous gamma-globulin in pregnancy: a

review. Obstet Gynecol Surv. 1989;44:25–34. Epub 1989/01/01.

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.

 

Religious objection 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.

https://pubmed.ncbi.nlm.nih.gov/10685306/

https://pubmed.ncbi.nlm.nih.gov/11731664/ SnMP to prevent exchange transfusion in children of Jehova’s Witnesses

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719714/

 

Steroids and MCA Scans

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).

Antenatal corticosteroid therapy: a comparative study of dexamethasone and betamethasone effects on fetal Doppler flow velocity waveforms. Urban R1, Lemancewicz A, Przepieść J, Urban J, Kretowska M. Conclusion: Our results indicate significant decrease in fetal middle cerebral artery impedance at 72 h after maternal administration of the first dose of dexamethasone. https://www.ncbi.nlm.nih.gov/pubmed/15925046

Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry. Piazze JJ1, Anceschi MM, La Torre R, Amici F, Maranghi L, Cosmi EV. Conclusion: Betamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages <32 weeks’. https://www.ncbi.nlm.nih.gov/pubmed/11146241

The combined effect of betamethasone and ritodrine on the middle cerebral artery in low risk third trimester pregnancies. Piazze J1, Anceschi MM, Cerekja A, Cosmi E, Meloni P, Alberini A, Pizzulo S, Argento T, Cosmi EV. 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. https://www.ncbi.nlm.nih.gov/pubmed/17343544

The effect of betamethasone and dexamethasone on fetal heart rate patterns and biophysical activities. A prospective randomized trial. Rotmensch S1, Liberati M, Vishne TH, Celentano C, Ben-Rafael Z, Bellati U. 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. https://www.ncbi.nlm.nih.gov/pubmed/10376858

Effect of antenatal corticosteroid administration on Doppler flow velocity parameters in pregnancies with absent or reverse end-diastolic flow in the umbilical artery. Müller T1, Nanan R, Dietl J. In contrast, there was an overall drop of pulsatility in the middle cerebral artery. https://www.ncbi.nlm.nih.gov/pubmed/12911438

The short term fetal cardiovascular effects of corticosteroids used in obstetrics. Amanda Henry, MPH, FRANZCOG, B.Med. (Hons) Talks about the average MoM drop is 0.3 after steroids. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029999/

Effects of maternal dexamethasone administration on fetal Doppler flow velocity waveforms. Chitrit Y, Caubel P, Herrero R, Schwinte AL, Guillaumin D, Boulanger MC. 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. https://www.ncbi.nlm.nih.gov/pubmed/10759269

Changes in fetoplacental vessel flow velocity waveforms following maternal administration of betamethasone. Edwards A, Baker LS, Wallace EM. Saw a decrease in MoM at 24 hours. https://www.ncbi.nlm.nih.gov/pubmed/12230445

Vaginal versus intramuscular progesterone in the prevention of preterm labor and their effect on uterine and fetal blood flow. Azza A.Abd El Hameed. A statistically significant decrease in fetal MCA-PI was noted after progesterone administration both vaginally and IM. http://www.sciencedirect.com/science/article/pii/S1110569011001336

https://www.ncbi.nlm.nih.gov/pubmed/15925046

https://www.ncbi.nlm.nih.gov/pubmed/11146241

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029999/

https://www.ncbi.nlm.nih.gov/pubmed/10759269

http://www.sciencedirect.com/science/article/pii/S1110569011001336

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312248/

 

Thrombocytopenia 

van den Akker ES, de Haan TR, Lopriore E, Brand A, Kanhai HH, Oepkes D. Severe fetal thrombocytopenia in Rhesus D alloimmunized pregnancies. Am J Obstet Gynecol. 2008 Oct;199(4):387.e1-4. doi: 10.1016/j.ajog.2008.07.001.

Koenig JM, Christensen RD. Neutropenia and thrombocytopenia in infants with Rh hemolytic disease. Journal of Pediatrics. J Pediatr. 1989 Apr;114(4 Pt 1):625-31. doi:10.1016/S00223476(89)80709-7.

https://www.nlm.nih.gov/medlineplus/ency/article/000586.htm

http://learn.pediatrics.ubc.ca/body-systems/neonate/neonatal-thrombocytopenia/

https://www.karger.com/Article/Abstract/343261

 

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