What may be done for a mother with rising anti-E titers and beginning signs of fetal distress?

For a mother with rising anti-E titers and beginning signs of fetal distress, performing plasmapheresis to remove anti-E immunoglobulins from the mother is a critical intervention. The presence of these antibodies can lead to hemolytic disease of the fetus and newborn (HDFN), where the mother's immune system attacks the fetal red blood cells, potentially causing severe anemia and other complications for the fetus.

Plasmapheresis is a procedure that removes plasma containing antibodies from the maternal circulation, thereby reducing the levels of anti-E in the mother's blood. This can help alleviate the risk posed by the antibodies to the developing fetus, especially in cases where fetal distress is evident. By lowering the antibody levels, the procedure may improve fetal outcomes and provide a better chance for the fetus to maintain a stable condition.

In contrast, inducing labor for early delivery might not be the best first-line approach unless the fetal condition is particularly critical. Administering Rh immunoglobulin (RhIg) is specifically indicated for Rh-negative mothers with anti-D antibodies, but not typically for those with anti-E antibodies. Performing an intrauterine transfusion using E-negative cells may also be necessary in severe cases of fetal anemia but is usually a subsequent step taken after careful evaluation