1 Fetal anemia: Diagnosis and management Federico Prefumo, Consultant Obstetrician * , Anna Fichera, Consultant Obstetrician, Nicola Fratelli, Consultant Obstetrician, Enrico Sartori, Professor of Obstetrics and Gynaecology Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy Keywords: Anemia Fetal therapy Hemolytic disease Intrauterine blood transfusion Rh-isoimmunization abstract Fetal anemia has been known for many years as a dangerous complication of pregnancy. Its most common causes are maternal alloimmunization and parvovirus B19 infection, although it can be associated with many different pathological conditions including fetal aneuploidies, vascular tumors, and arteriovenous malforma- tions of the fetus or placenta and inherited conditions such as alpha-thalassemia or genetic metabolic disorders. Doppler ultra- sonographic assessment of the peak velocity of systolic blood flow in the middle cerebral artery for the diagnosis of fetal anemia and intravascular intrauterine transfusion for its treatment are the current practice standards. Live birth rates as high as 95% have been reported in recent years. The additional role of intravenous immunoglobulin therapy and the long-term consequences of the condition are the subjects of active ongoing research. © 2019 Elsevier Ltd. All rights reserved. Introduction The diagnosis and treatment of the most common form of fetal anemia, hemolytic disease of the fetus and newborn (HDFN), has been at the leading edge of fetal diagnosis and therapy for decades [1]. The need to assess the fetal status in HDFN was pivotal in the development of amniocentesis as a * Corresponding author. Department of Obstetrics and Gynaecology, University of Brescia, Piazzale Spedali Civili, 1, Brescia, 25123, Italy. E-mail address: federico.prefumo@unibs.it (F. Prefumo). Contents lists available at ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn https://doi.org/10.1016/j.bpobgyn.2019.01.001 1521-6934/© 2019 Elsevier Ltd. All rights reserved. Best Practice & Research Clinical Obstetrics and Gynaecology 58 (2019) 2e14