Haemolytic Disease of Fetus and Newborn

Coombe Women & Infants University Hospital Annual Report 2020

One midwife commenced a Masters in Ultrasound in September whilst another midwife completed the Masters in Ultrasound in December. Online learning commenced in view of the COVID-19 pandemic. Staff availed of the multiple webinars provided by The Fetal Medicine Foundation. Machinery was upgraded with the installation of an E10 ultrasound machine.

The ultrasound and fetal medicine service at the CWIUH provided a comprehensive service in the specialist areas of fetal abnormalities, invasive and non-invasive testing, multiple pregnancies, haemolytic disease of the fetus and screening for preterm birth. As a tertiary referral centre, we provided support and co-ordinated shared care with maternity units outside Dublin for women whose babies require planned delivery in Dublin in order to facilitate urgent transfer to a paediatric surgical centre or specialised neonatal care. We have a multi-disciplinary network, consisting of neonatology, paediatric sub-specialties in CHI, clinical genetics, radiology, medical social work and bereavement support, to provide comprehensive care to women and their families following a prenatal diagnosis of a fetal abnormality. Sadly, 27 families received the diagnosis of a fatal fetal abnormality/life limiting condition in 2020. Seventeen women had a termination of pregnancy and 10 women continued the pregnancy with perinatal palliative care.

CONDOLENCES In October 2020, we sadly lost a beautiful friend and colleague, Siobhán Ní Scanaill (1960 - 2020). Siobhán was a Clinical Midwife Specialist with over 25 years’ ultrasound experience. Her expertise and knowledge of ultrasound was outstanding. Siobhán was a highly valued member of our ultrasound team and we all miss her friendship, kindness and humour so much. May she rest in peace.

An isoimmunisation guideline was developed to facilitate the management of women with red cell antibodies by their team clinicians. Using the guideline algorithm, women are referred to the Rhesus Clinic if the threshold antibody levels for ultrasound surveillance are reached. Women with previously affected pregnancies and those with high risk antibodies are managed in the Rhesus Clinic.

Pregnant women who develop or present with significant red cell antibodies in pregnancy are referred to the Rhesus team for evaluation. Where clinically significant red cell antibodies are detected, the paternal genotype is determined by serology. The Rhesus D (RhD) status of the fetus can be ascertained, when indicated, by extracting free fetal DNA from the maternal plasma. At risk pregnancies are followed using antibody levels and/or ultrasound surveillance using middle cerebral artery peak systolic flow velocities to detect fetal anaemia.

Forty-one women were referred to the Rhesus Clinic in 2020 (table 1.10.1). Thirty-one women of these women were diagnosed with red cell antibodies for the first time. Two women had multiple red cell antibodies. No intrauterine red cell transfusions were required. Fourteen neonates had a positive Direct Coombs Test (DCT) at birth (table 1.10.1). Six neonates required admission to the Special Care Baby Unit (SCBU) for phototherapy (table 1.10.2). Two neonates required intravenous immunoglobulin (IVIG) in addition to phototherapy and one of these neonates also required a blood transfusion.