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This chapter discusses the role of fetal therapy for fetal anemia, which has been one of the success stories of fetal medicine. There is a risk of red cell alloimmunization in any pregnancy where the mother is exposed to fetal red cells that possess antigens for which her own red cells are negative. A number of pregnancy-related events are associated with a risk of fetomaternal hemorrhage (FMH). A number of techniques have evolved over time to facilitate assessment of pregnancies at risk of 'hemolytic disease of the fetus and newborn' (HDFN). The aim of assessment is to identify the anemic fetus requiring intrauterine transfusion (IUT) before hydrops fetalis develops. However, monitoring an identified at-risk pregnancy to the point at which hydrops fetalis develops would be considered a management failure. Although less common than RhD disease, profound fetal anemia, hydrops, and intrauterine death can result from Kell alloimmunization.
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