Prenatal diagnosis and management of bleeding disorders with fetal blood sampling

The technique of fetal blood sampling for prenatal diagnosis has been shown to be both feasible and safe. The availability of fetal blood for direct evaluation has changed our attitude about the problems of both hereditary and acquired immune fetal bleeding disorders. We can continue with the classic approach and use fetal blood sampling for those conditions in which termination may be recommended, but we can also investigate less severe disorders in which the diagnosis allows us to plan the management of the pregnancy and minimize intrapartum and neonatal complications. We report our experience in prenatal diagnosis and management of 103 cases of hereditary and 18 cases of acquired immune bleeding disorders. We have developed specific management plans depending on the disorder under investigation, the severity of the condition in the fetus, and parental wishes. We have performed in utero transfusions of platelets and factor concentrate where appropriate. Efficacy of maternal therapy for fetal conditions can be directly assessed during gestation. Mode of delivery is determined by obstetric conditions and fetal status, directly assessed after appropriate therapy. Closer surveillance of the fetus by fetal blood sampling gives precise information on which to base clinical decisions to provide optimal maternal and fetal outcome.