In recent years, indications for fetal blood sampling (FBS) have been reduced thanks to the introduction of advanced technologies that achieve the same or superior diagnostic results earlier and through less invasive procedures, such as fetal cell free DNA analysis, amniocentesis, or chorionic villi sampling. Indeed, FBS could result in serious complications such as bleeding from the umbilical cord access, fetal bradycardia, fetal loss, and maternal complications such as hemorrhage or maternal alloimmunization. Only few selected cases of severe fetal anemia, hydrops secondary to fetal anemia, or fetal thrombocytopenia are current indications to perform FBS. The reduction in number of procedures performed annually affects the availability of training opportunities for future operators. This imposes a limit on the diffusion of the FBS technique, which should be performed by experienced operators at centers with expertise in invasive fetal procedures. On the other hand, most cases of severe fetal anemia, which is the most common indication for FBS, can be diagnosed accurately and followed with Doppler ultrasonography, and treatment of anemia can be postponed after the induction of preterm delivery.

Indeed, in developed countries, there has been a reduction in perinatal morbidity and mortality rates among medically indicated preterm births, thanks to the implementation of neonatal intensive care units. Survival rates for very low birthweight babies have increased steadily, but long-term outcome of preterm infants has not changed over the past 10 years. The gestational age at intervention remains the most important prognostic factor in cases of preterm birth induction as well as in FBS.

In conclusion, FBS is an invasive procedure with possible severe complications and so rarely performed. Although the overall success rate of FBS is high, there are a lack of data on the long-term outcome of pregnancies that were submitted to this procedure. On the other hand, noninvasive treatment of fetal anemia with an induced preterm birth and postnatal care seems, in most cases, to be a safer option for both mother and fetus. In our opinion, future guidelines will have to compare FBS with postnatal treatment of fetal anemia in relation to different gestational ages. To this end, it will be essential that patients are seen at specialized centers with expertise in invasive fetal therapies and to adopt standardized procedures.