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Vol. 16, No. 5, 2001
Issue release date: September–October 2001
Fetal Diagn Ther 2001;16:294–298
(DOI:10.1159/000053931)

Management of Anti-Rhesus-D Antibodies in Pregnancy: A Review from 1994 to 1998

Cheong Y.C. · Goodrick J. · Kyle P.M. · Soothill P.
aFetal Medicine Research Unit, University of Bristol, St. Michael’s Hospital, Bristol, and bDepartment of Haematology, Frenchay Hospital, Bristol, UK

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Abstract

Objective: To review our management of anti-Rhesus-D antibodies in pregnancy over a 5-year period in order to assess possible changes in the management or prognosis which may have developed with time. Method: Retrospective analysis of prospectively collected data from 31 pregnancies with maternal anti-D levels >4 IU/ml and in which the fetus was Rhesus positive. Results: There were a total of 30 amniocenteses, 8 cordocenteses, and 54 fetal blood transfusions performed. When undertaken as the first procedure, the mean gestational age at amniocentesis was 30 weeks as compared with 25 weeks for fetal blood sampling/transfusion (p < 0.05). The median anti-D level at the first procedure was 24 IU/ml for amniocentesis and 64 IU/ml for fetal blood sampling. Of the 54 blood transfusions, 43 were intravascular, 4 were intraperitoneal, and 7 transfusions were both intravascular and intraperitoneal. Conclusions: Intravascular as opposed to intraperitoneal transfusions were found to be the main method of transfusion in the later years in this study, a finding which was expected with improved sonographic equipment. Apart from this, management and prognosis of anti-D red cell isoimmunisation in pregnancy have remained relatively stable since the 1980s. Amniocentesis was useful in the management of such pregnancies, especially as an initial procedure in the cases with a lower initial anti-D level. In this series 90% of the fetuses requiring blood transfusion, but were without hydrops, survived, whereas this was about 70%, if they had become hydropic (this latter figure was reduced by 2 hydropic deaths before 20 weeks’ gestation in the same very severely affected woman).



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References

  1. MacKenzie IZ, Selinger M, Bowell PJ: Management of red cell isoimmunisation in the 1990s. Prog Obstet Gynecol 1989;9:31–53.
  2. Clarke C, Hussey RM: Decline in deaths from Rhesus haemolytic disease of the newborn. J R Coll Physicians Lond 1994;28:310–311.
  3. Whitfield CR, Raafat A, Urbaniak SJ: Underreporting of mortality from RhD haemolytic disease in Scotland and its implications: Retrospective review. BMJ 1997;vol 315:1504–1505.
  4. Nicolaides KH, Clewell WH, Mibashan RS, Soothill PW, Rodeck CH, Campbell S: Fetal haemoglobin measurement in the assessment of red cell isoimmunisation. Lancet 1988;i:1073–1075.
  5. Nicolaides KH, Rodeck CH, Millar DS, Mibashan RS: Fetal haematology in rhesus isoimmunisation. Br Med J 1985;290:661–663.
  6. Weiner CP, Williamson RA, Wenstrom KD, Sipes SL, Grant SS, Widness JA: Management of fetal haemolytic disease by cordocentesis. Am J Obstet Gynecol 1991;165:546–553.
  7. Nicolaides KH, Fontanorosa M, Gabbe SG, Rodeck CH: Failure of ultrasonographic parameters to predict the severity of fetal anaemia in rhesus isoimmunisation. Am J Obstet Gynecol 1988;158:920–926.

    External Resources

  8. Nicolaides KH, Rodeck CH, Mibashan RS, Kemp JR: Have Liley charts outlived their usefulness? Am J Obstet Gynecol 1986;155:90–94.
  9. Parer JT: Severe Rh isoimmunisation – current methods of in utero diagnosis and treatment. Am J Obstet Gynecol 1988;158:1323–1329.

    External Resources

  10. Vaughan JL, Manning M, Warwick RM, Letsky EA, Murray NA, Roberts IA: Inhibition of erythroid progenitor cells by anti-Kell antibodies in fetal alloimmune anaemia. N Engl J Med 1998;338:798–803.
  11. Liley AW: Liquor amnii analysis in the management of pregnancy complicated by rhesus sensitisation. Am J Obstet Gynecol 1961;82:1359–1370.
  12. Scott F, Chan FY: Assessment of the clinical usefulness of the ‘Queenan’ chart versus the ‘Liley’ chart in predicting severity of rhesus isoimmunisation. Prenat Diagn 1998;18:1143–1148.
  13. Nicolaides KH, Soothill PW, Rodeck CH, Clewell W: Rh disease: Intravascular fetal blood transfusion by cordocentesis. Fetal Ther 1986;1:185–192.

    External Resources

  14. Nicolaides KH, Clewell W, Rodeck CH: Measurement of human fetoplacental blood volume in erythroblastosis fetalis. Am J Obstet Gynecol 1986;157:50–53.
  15. Nicolini U, Kochenour NK, Greco P, Letsky E, Rodeck CH: When to perform the next intrauterine transfusion in patients with Rh allo-immunisation: Combined intravascular and intraperitoneal transfusion allows longer intervals. Fetal Ther 1989;4:14–20.
  16. MacKenzie IZ, Bowell PJ, Castle BM, Selinger M, Ferguson JF: Serial fetal blood sampling for the management of pregnancies complicated by severe rhesus (D) isoimmunisation. Br J Obstet Gynaecol 1988;95:753–758.
  17. Moise KJ, Schumacher B: Anaemia; in Fisk NM, Moise KJ (eds): Fetal Therapy: Invasive and Transplacental. Cambridge, Cambridge University Press, 1997, pp 141–163.
  18. Vintzileos AM, Campbell WA, Storlazzi E, Mirochnick MH, Escoto DT, Nochimson DJ: Fetal liver ultrasound measurements in isoimmunized pregnancies. Obstet Gynecol 1988;68:162–167.
  19. Oepkes D, Meerman RH, Vandenbussche FP, van Kamp IL, Kok FG, Kanhai HH: Ultrasonographic fetal spleen measurements in red blood cell alloimmunized pregnancies. Am J Obstet Gynecol 1993;69:121–128.
  20. Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, Dorman KF, Ludomirsky A, Gonzalez R, Gomez R, Oz U, Detti L, Copel JA, Bahado-Singh R, Berry S, Martinez-Poyer J, Blackwell SC: Noninvasive diagnosis by Doppler ultrasonography of fetal anaemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000;342:9–14.
  21. Hadley AG, Wilkes A, Goodrick J, Penman D, Soothill P, Lucas G: The ability of the chemiluminescence test to predict clinical outcome and the necessity for amniocentesis in pregnancies at risk of haemolytic disease of the newborn. Br J Obstet Gynaecol 1998;105:231–234.


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