Haemolytic disease of the newborn infant. Long term efficiency of the screening and the prevention of alloimmunization in the mother: thirty years of experience

Moncharmont, P.; Dupraz, F. Juron; Vignal, M.; Rigal, Dominique; Meyer, Francis; Debeaux, P.

doi:10.1007/bf02390356

“…We have observed an incidence of 0.57% for all detected antibodies and 0.24% for antibodies that are potentially clinically significant. Our findings agree with Moncharmont et al (15) who reported an incidence of 0.25% during a similar study period. However, the findings of other workers do differ (8,9,16).…”

Section: Discussionsupporting

confidence: 94%

The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn:

Filbey

¹

,

Hanson

²

,

Wesström

³

1995

Acta Obstet Gynecol Scand

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Few antibodies to blood group antigens other than those in the Rhesus system were found to cause severe HDN. Antibodies that are generally considered non-significant did not cause HDN in this study. All antibodies that induced HDN were detected in time so that adequate measures could be taken to reduce the effects in the newborn. The antenatal screening and management programme currently in use is considered to be reliable.

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“…Although anti‐Rh D prophylaxis was introduced in the 1960s in most western countries for Rh D negative women to prevent immunisation against paternally derived fetal or neonatal Rh D antigen, alloimmunisation in the US and Canada is estimated to currently affect 1.3 cases/1000 total births in the 1990s 1 . Similar results were observed in other developed countries 2–4 . The primary cause of maternal alloimmunisation is sensitisation to the D antigen of the rhesus (Rh) blood group system 5 .…”

Section: Introductionsupporting

confidence: 74%

“…Units of transfused blood are not routinely cross‐matched for antigens other than Rh and ABO groups. In the US, the incidence of maternal alloimmunisation to clinically significant antigens has been estimated to be 25 per 10,000 live births 7 , which is similar to the incidence reported in Sweden 4 .…”

Section: Introductionsupporting

confidence: 51%

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention‐to‐treat

Zimmermann

¹

,

Dürig

²

,

Carpenter

³

et al. 2002

BJOG

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Objective To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design Prospective study on an intention-to-treat basis.Setting Multicentre study in five large tertiary referral centres.Population One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7 -14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure Moderate to severe anaemia at delivery.Results Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

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“…Units of transfused blood are not routinely cross-matched for antigens other than Rh and ABO groups. In the US, the incidence of maternal alloimmunisation to clinically significant antigens has been estimated to be 25 per 10,000 live births 7 , which is similar to the incidence reported in Sweden 4 . Among fetuses at risk for immunological hydrops, up to 25% require intrauterine transfusions due to severe anaemia.…”

Section: Introductionmentioning

confidence: 53%

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

Zimmermann¹

2002

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective To evaluate the utilisation measurements of peak systolic velocities in the middle cerebral artery combined with B-mode ultrasound imaging to predict anaemia in an unselected population of pregnancies complicated by alloimmune antibodies known to cause immunological hydrops. Design Prospective study on an intention-to-treat basis.Setting Multicentre study in five large tertiary referral centres.Population One hundred twenty-five fetuses with maternal alloantibodies known to cause immunological hydrops. Methods If peak systolic velocity and B-mode scan were reassuring the pregnancy was monitored at 7 -14 days interval. If either method showed signs of anaemia, an umbilical fetal blood sampling was performed. When the gestational age was greater than 35 weeks, labour was induced. Main outcome measure Moderate to severe anaemia at delivery.Results Overall sensitivity to detect moderate to severe anaemia below 35 weeks (haemoglobin level below 0.65 multiples of median) was 88%. Specificity was 87%; positive predictive value was 53% and negative predictive value was 98%. The diagnosis of severe anaemia was missed in one fetus; however, the final outcome was good. The method was not useful after 35 weeks. Conclusions Middle cerebral artery peak systolic velocity is a highly sensitive non-invasive means for determining the degree of anaemia present in red blood cell alloimmunised pregnancies. The widespread use of the Doppler method will minimise fetal complications associated with amniocentesis and fetal blood sampling. Non-invasive measurement of middle cerebral artery peak systolic velocities is more convenient and acceptable to alloimmunised pregnancies and may significantly lower health care costs. A Doppler interval of seven days is recommended.

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Haemolytic disease of the newborn infant. Long term efficiency of the screening and the prevention of alloimmunization in the mother: thirty years of experience

Cited by 13 publications

References 10 publications

The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn:

The prevalence of red cell antibodies in pregnancy correlated to the outcome of the newborn:

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention‐to‐treat

Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat

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