Prenatal Decision Tree

The Prenatal Decision Tree can be used as a step by step guide through the proper course of prenatal care for alloimmunized patients according to current medical literature. If your care plan differs from this, discuss it with your physicians and seek a second opinion if needed. For additional references and a more in-depth explanation of the information in this tree, please see our Providers page. When you click submit, there will be an option to download a PDF copy of your tree for your records. You may print, save, or discard this copy. This interactive tool is based on a flow chart provided by Dr. Kenneth Moise. To view the complete chart, click the image below. .


Disclaimer: This website does not provide specific medical advice or recommendations for individual patients. The Allo Hope Foundation strongly recommends that care and treatment related to alloimmunization and HDFN be made in consultation with your physicians who are familiar with your individual health situation. Individuals should not rely on the information posted on this website as a substitution for speaking with qualified healthcare professionals. As in every case, your unique medical needs and conditions require a healthcare provider familiar with your situation. While the Allo Hope Foundation can provide resources and education about current standards of care and current medical literature, we cannot be used as a substitute for qualified medical care. 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our web site content is frequently updated, medical information changes rapidly and therefore, some information may be out of date, and/or contain inaccuracies or typographical errors.

References

  1. 1. Moise Jr KJ, Kennedy MS. Management of non-RhD Red Blood Cell Alloantibodies During Pregnancy. https://www.uptodate.com/contents/management-of-non-rhd-red-blood-cell-alloantibodies-during-pregnancy . Cited April 17, 2020
  2. 2. ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Obstet Gynecol. 2018;131(3):e82–e90. doi:10.1097/AOG.0000000000002528
  3. 3. Green-top Guideline No. 65 - The Management of Women with Red Cell Antibodies during Pregnancy. Obstet Gynecol. 2014; 16: 224-224. https://doi.org/10.1111/tog.12125..
  4. 4. Titers 4 fold increase.
  5. 5. AHF Prenatal tree courtesy of Dr Moise.
  6. 6. Moise Jr KJ. Overview of RhD alloimmunization in pregnancy. UpToDate. https://www.uptodate.com/contents/management-of-pregnancy-complicated-by-rhd-alloimmunization. Cited March 24, 2020.
  7. 7. Alloimmunization III - Management of Alloimmunized Pregnancy With At Risk Fetus. UNC Center for Maternal & Infant Health. Retrieved from https://www.mombaby.org/wp-content/uploads/2018/02/Alloimmunization-III_-Managment-of-Alloimmunized-Pregnancy-with-at-Risk-Fetus-2.pdf. Accessed 4/17/2020
  8. 8. Bowman JM, Pollock JM. Transplacental fetal hemorrhage after amniocentesis. Obstet Gynecol 1985; 66(6):749-754.
  9. 9. Abu-Rustum RS, Ziade MF, Ghosn I, Helou N. Normogram of Middle Cerebral Artery Doppler Indexes and Cerebroplacental Ratio at 12 to 14 Weeks in an Unselected Pregnancy Population. Am J Perinatol. 2019;36(2):155–160. doi:10.1055/s-0038-1661404
  10. 10. Moise Jr KJ. Intrauterine Fetal Transfusion of Red Cells. UpToDate. https://www.uptodate.com/contents/intrauterine-fetal-transfusion-of-red-cells. Cited April 17, 2020
  11. 11. Mari G, Norton ME, Stone J, Berghella V, Sciscione AC, Tate D, Schenone MH. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia--diagnosis and management. J Obstet Gynecol. 2015 Jun;212(6):697-710. doi: 10.1016/j.ajog.2015.01.059.
  12. 12. Moise KJ Jr. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol. 2008;112(1):164–176. doi:10.1097/AOG.0b013e31817d453c. 2002;100(3):600–611. doi:10.1016/s0029-7844(02)02180-4
  13. 13. ACOG COMMITTEE OPINIONNumber 818 - Medically Indicated Late-Preterm and Early-Term Deliveries. Obstet Gynecol 2021; 137(2).