Fetal Medicine Unit: Need of the Hour at Tertiary Care Centers in India?

Abstract

Aim: The aim of the article was to emphasize the need for a fetal medicine unit at tertiary care hospitals. Background: The incidence of Rh-negative in India is 5–10%. The issue of Rh incompatibility arises when the mother is Rh-negative and the fetus is Rh-positive. Rh alloimmunization can lead to fetal anemia, hydrops fetalis, and even intrauterine death. It leads to perinatal loss of 1–2.5%. Fetal anemia is a serious complication in pregnancy and is associated with perinatal morbidity and mortality. Intrauterine transfusion (IUT) is a good treatment option for fetal anemia due to Rh incompatibility. Intravascular transfusion offers the best chance of survival to fetuses severely affected with Rh isoimmunization, overall survival exceeding 80%. In the cases with detectable antibodies, prenatal monitoring of maternal antibody titers and fetal middle cerebral arterial-peak systolic velocity (MCA-PSV) Doppler ultrasound assessment helps to plan fetal blood sampling and IUT procedures. Thus, the establishment of fetal medicine unit at tertiary care centers in India is need of the hour. Case description: We report a case of 32-year-old G4P3L1END1IUD1 with Rh-negative sensitized pregnancy with fetal anemia, managed successfully with IUT. Clinical significance: Early diagnosis of fetal anemia by serial MCA-PSV measurements and referral to fetal medicine unit are important for improving the outcome in Rh-negative sensitized pregnancies. Conclusion: Establishment of fetal medicine unit at tertiary care centers is the need of the hour to improve the fetal outcome in high-risk pregnancies like Rh-negative pregnancy.