Journal Mobile Options
Table of Contents
Vol. 16, No. 5, 2001
Issue release date: September–October 2001
Fetal Diagn Ther 2001;16:294–298

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

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


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).

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  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.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50