Bridging the gaps: prevention, management, and future perspectives in hemolytic disease of the fetus and newborn

Abstract

This thesis describes the major progress in the prevention and treatment of hemolytic disease of the fetus and newborn (HDFN), which has become rare in the Netherlands. The research focuses on improving D-immunization prevention, optimizing intrauterine transfusions (IUTs), and enhancing counseling and care in subsequent high-risk pregnancies.

A key component is the evaluation of the Dutch screening program for fetal RHD genotyping. Technical improvements, such as adding an in-process control, increased reliability and further reduced false-negative results. The study also highlights the importance of accounting for genetic variation across different ethnic groups to ensure equitable and accurate care.

In addition, findings suggest that combined transfusion techniques may improve hemoglobin levels and extend intervals between treatments. In subsequent pregnancies, HDFN frequently recurs, often earlier and with similar or increased severity, although outcomes can still be favorable with proper management. The thesis also examines placental changes in HDFN and finds no adverse effects of donor red blood cells on placental structure. Finally, all evidence is integrated into a new multidisciplinary Dutch guideline, emphasizing early detection, risk-based monitoring, and tailored treatment. Future perspectives include earlier fetal RHD testing and improved prediction models to better target care and reduce unnecessary interventions.