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At least 19 recordsLinked to original sources
PubMed1978

Antenatal prophylaxis of Rh isoimmunization: 28-weeks'-gestation service program.

Two (0.18%) of 1086 Rh-negative primigravidas or multigravidas treated similarly in all previous pregnancies, who were given a single injection of Rh immune globulin (300 mug) at 28 weeks' gestation and subsequently were delivered of Rh-positive babies, had demonstrable Rh isoimmunization at the time of that injection and must be considered "logistic" failures of antenatal prophylaxis. The remaining 1084 (who were treated again after delivery) had no evidence of Rh isoimmunization at delivery and none of the 512 screened at 6 months after delivery appeared to be immunized. If the 28th-week injection had not been protective, one would have expected 14 of the 1084 to have been demonstrably Rh isoimmunized and evidence of Rh isoimmunization to have persisted in 6 of the 512 observed 6 months after delivery.Six of 719 Rh-negative multigravidas who had not received Rh immune globulin after previous pregnancies or had been treated only after delivery showed evidence of Rh isoimmunization despite a single injection of Rh immune globulin at 28 weeks in a subsequent pregnancy. In three of the six the cause was most likely "sensibilization" due to previous exposure to Rh-positive blood or an untreated Rh-positive pregnancy. in 3 of the remaining 716 (0.42%) there may have been true failure of antenatal Rh prophylaxis administered at the 28th week. One would have expected this figure to be 12 of 716 if antenatal Rh prophylaxis at 28 weeks' gestation were totally unsuccessful.It is concluded that a single intramuscular injection of Rh immune globulin, 300 mug, is 88% effective in preventing Rh isoimmunization during pregnancy in Rh-negative primigravidas and in multigravidas treated antenatally in all previous pregnancies, and is 75% effective in preventing Rh isoimmunization in Rh-negative multigravidas untreated during previous pregnancies. The majority of failures are due to Rh isoimmunization during pregnancy prior to antenatal prophylaxis at 28 weeks.

Antibody Formation↗
PubMed1978

Rh isoimmunization during pregnancy: antenatal prophylaxis.

Of 3533 Rh-negative women who began a pregnancy without detectable Rh antibodies, 62 (1.8%) demonstrated evidence of Rh isoimmunization during pregnancy or within 3 days after delivery. All denied transfusions as well as abortions or previous pregnancies not followed by the administration of Rh immune globulin. Rh isoimmunization during pregnancy or within 3 days after delivery, which will not be prevented by the administration of Rh immune globulin after delivery, is the most important cause of residual Rh isoimmunization. A clinical trial of antenatal administration of Rh immune globulin, initially at 34 weeks's and subsequently at 28 and 34 weeks' gestation, in 1357 Rh-negative pregnant women who were delivered of Rh-positive babies, was effective in preventing the development of Rh isoimmunization during pregnancy or within 3 days after delivery. Antenatal prophylaxis with Rh immune globulin will be necessary if the incidence of Rh isoimmunization is to be reduced to its lowest possible level. Antenatal prophylaxis at 28 weeks' gestation is now an insured service in Manitoba.

Antibody Formation↗
PubMed1977

Rh isoimmunization, Manitoba, 1963-75.

The number of Rh-isoimmunized pregnancies in Manitoba has been reduced from 223 and 228 in the years ending Oct. 31, 1963 and 1964 to 60 and 62 in the years ending Oct. 31, 1974 and 1975. The number per 1000 total births in the same years has decreased from 10.0 and 10.6 to 3.4 and 3.5 Perinatal mortality rates in those years decreased from 13.8 amd 15.7% to 0 and 2.2%, respectively. The number of perinatal deaths has been reduced from 55 in the first 2 years reported to 1 in the last 2 years. Among the 121 isoimmunized women pregnant in the 2-year period ending Oct. 31, 1975, isoimmunization was due to failure to give Rh immune globulin after delivery in 33 and failure to give it during pregnancy in 48. Of the remaining 40, 37 were immunized before Rh immune globulin became available. Complete prevention of Rh isoimmunization and therefore of all perinatal deaths from Rh erythroblastosis can only be achieved through universal Rh testing prenatally and immediately after delivery, and institution of an antenatal Rh prophylaxis program.

Antibody Formation↗
PubMed1988

Intravascular fetal blood transfusion under ultrasonic guidance in a case of severe Rh isoimmunization.

A severely Rh-affected fetus with an initial hematocrit value of 7% and a hemoglobin value of 2.3 g/dl was transfused three times by the intravascular route into the umbilical cord under ultrasonic guidance. After the second transfusion, fetal movements recurred and the non-stress test became reactive. Neonatal outcome was favorable. The implications of this procedure are discussed.

Adult↗
PubMed1987

Relationship of fetal hemoglobin and oxygen content to lactate concentration in Rh isoimmunized pregnancies.

Fetal blood samples were obtained fetoscopically from 32 Rh isoimmunized pregnancies at 18-32 weeks' gestation, and the hemoglobin concentration, plasma lactate concentration, and oxygen content were measured. When the hemoglobin concentration was more than 8 g/dL, the umbilical arterial and venous lactate concentrations were equal. Abnormal elevations of lactate were found in the umbilical artery at hemoglobin concentrations below 8 g/dL (oxygen content 2 mmol/L) and in the umbilical vein at hemoglobin concentrations below 4 g/dL (oxygen content 2 mmol/L); the arterial lactate values were higher than the venous. These results show that lactate is produced by the human fetus stressed by anemic hypoxia and suggest that compensatory cardiovascular mechanisms are unable to maintain adequate oxygenation to all tissues when the umbilical venous oxygen content falls below 2 mmol/L.

Anemia↗
PubMed1991

Rh isoimmunization complicating a triplet gestation. A case report.

A case occurred of Rh isoimmunization complicating a triplet gestation. Management of that extremely rare situation required careful attention to the problems inherent in both multiple pregnancy and isoimmunization. Amniocentesis and frequent antepartum fetal monitoring were the cornerstones of therapy.

Adult↗
PubMed1989

Acute Rh isoimmunization following abdominal trauma associated with late abruption placenta.

Acute exacerbation of Rh isoimmunization following abdominal trauma is a rare complication of pregnancy. The report describes a case of a mild case of erythroblastosis fetalis following maternal exposure to massive fetal-maternal transfusion, occurring after abdominal injury in motoring accident. Abruptio placenta 7 days following the trauma indicated emergency cesarean section, at which a severely affected fetus (erythroblastosis fetalis) was delivered. Late abruption--in the presence of no other risk factor--is considered to call for prolonged surveillance. Any abdominal trauma in a Rh-negative woman should alert one to the possibility of massive transplacental hemorrhage and augmentation of the maternal immune response.

Abdominal Injuries↗
PubMed1990

Fetal heart rate responses to anemia in Rh isoimmunization.

On 52 occasions 24 Rh immunized women were monitored with a nonstress test (NST) prior to fetal blood sampling. Cardiotocographic characteristics were recorded for each NST. Fetal blood was analysed for hemoglobin and hematocrit. Fetal hemoglobin and hematocrit were positively correlated to long-term variability, acceleration amplitude and negatively correlated to deceleration amplitude (linear regression analysis; p less than 0.05). Decelerations were almost without exception associated with low concentrations of hemoglobin and hematocrit. In fetuses of 32 weeks' gestation or more, a loss of variability (less than or equal to 5 bpm) was associated with severe anemia. Hemoglobin and hematocrit were significantly lower in the group with a pathological NST (n = 15) compared with the group with a normal NST (n = 37) (Mann-Whitney U test; p less than 0.05). The predictive value of a pathological test was 13/15 concerning hemoglobin and hematocrit; whereas, the predictive value of a normal test was poor. A pathological NST, especially when decelerative, is a good predictor of fetal anemia, but a normal NST is no guarantee for a normal blood status.

Anemia↗
PubMed1989

Intrauterine transfusion via umbilical vein in severe Rh isoimmunization.

Although the widespread use of anti-D immune globulin has dramatically reduced the incidence of Rh isoimmunization, an occasional pregnant patient becomes a candidate for intrauterine transfusion because of sensitization to Rh antigens or irregular red blood cell antigens. Current methods of ultrasonography provide needle guidance to the umbilical vein, permitting fetal intravascular transfusion. We have reported a case involving five separate intrauterine transfusions via the umbilical vein.

Adult↗
PubMed1989

[Spectrophotometric characteristics of the amniotic fluid in Rh isoimmunization following intrauterine fetal blood transfusions].

The amniotic fluids of 7 pregnant women with Rh-isoimmunization were examined. On the basis of the data of this investigation as well as of the clinical and ultrasound data intrauterine blood transfusions were made in fetuses--from 4 to 8 in number. Forty two spectrophotometric analyses were made in all, but the amniotic fluids were examined before intrauterine blood transfusions as well as before the performance of each subsequent blood transfusion. The authors found changes in the characteristic of the amniotic fluid after intrauterine blood transfusion, which were manifested by the fact that the pigment peak of delta 450 nm was reduced, but the peak of delta 410 nm was increased. In connection with these findings after intrauterine blood transfusions delta 450 nm lost its diagnostic and prognostic value. delta 410 nm before intrauterine blood transfusions manifested gravity of fetal hemolytic disease. After intrauterine blood transfusions its increase was due to blood transfusions and accumulation of methemoglobin in the amniotic fluid.

Amniotic Fluid↗
PubMed1985

Compliance with postpartum Rh isoimmunization prophylaxis in Alberta.

A retrospective review of obstetric records for 1979 in two major Calgary hospitals was undertaken to determine the rate of compliance with postpartum Rh isoimmunization prophylaxis in Alberta. The charts of 4528 women ranging in age from 13 to 46 years were reviewed. The prevalence rate of Rh negativity was found to be 16%. Of the 710 Rh-negative women 490 (69%) were eligible to receive Rh immune globulin (RhIG); that is, they had no anti-D antibodies, and the baby/fetus was Rh-positive or Rh-unknown. RhIG had been administered to 93.6% of the eligible women; the compliance rate ranged from 66.7% for obstetric emergencies (i.e., spontaneous abortion, antepartum or early-pregnancy hemorrhage, or ectopic pregnancy) to 98.2% for postpartum diagnoses. In more than half (54.7%) of the women who underwent amniocentesis Rh type was not determined; the implications of this finding are discussed. Although poor compliance with postpartum RhIG administration is not a reason for withholding antepartum administration of RhIG, maximum compliance with the more cost-effective programs should be attained before antepartum programs are fully implemented.

Adolescent↗
PubMedDate not supplied

[Advantages of preventing Rh isoimmunization].

The authors analysed the frequency of Rh immunization from 1972 to 1983. The incidence of Rh-immunized women who after the birth of a Rh (D) positive child were not given anti-D immunoglobulin G and in subsequent pregnancies gave birth to a Rh (D) positive child was found to amount to 11.76%, while in women who were given anti-D immunoglobulin D this incidence was 0.77% (t = 5.98; p less than 0.05). Out of 29 Rh-immunized pregnant women, two developed Rh immunization in the course of the first pregnancy, three after the unsuccessful prevention of Rh immunization, and the rest after delivery or after delivery and abortion. Out of 29 Rh-immunized women, 27 (93.10%) were ABO-compatible and 2 (6.90%) ABO-incompatible with their child (p less than 0.05). In the first pregnancy the incidence of Rh immunization was 1.86 per 1000 deliveries in Rh negative pregnant women and 21.19 per 1000 deliveries in subsequent pregnancies (p less than 0.05). In the period observed there were 2.24 Rh immunizations per 1000 of all deliveries. From 1972 to 1977 there were 3.19 Rh immunizations per 1000 deliveries and from 1978 to 1983 only 1.43 (t = 2.08; p less than 0.05), which is a reduction by 55.17%. The perinatal mortality rate of children affected by Rh-hemolytic disease was 20%. In the last six years it has gone down by 60%, while the number of children with Rh-hemolytic diseases has been reduced by 50%.

Female↗
PubMed1990

A case of Rh isoimmunization: should threatened first-trimester abortion be an indication for Rh immune globulin prophylaxis?

Despite the recommended 28 weeks' gestation antenatal, postnatal, and postabortion prophylaxis with Rh immune globulin, residual Rh immunization still occurs in Rh-negative women. We describe a patient whose history suggests development of an anti-D antibody after first-trimester bleeding. To our knowledge, this is the first such case reported in the English literature.

Abortion, Threatened↗
PubMed1976

[Immunoglobulins and antibody titre in amniotic fluid of Rh-isoimmunized pregnant women (author's transl)].

On 90 samples of amniotic fluid coming from 54 cases of Rh-isoimmunization submitted to amniocentesis one or more times, the following tests were done: 1.) Coombs indirect test; 2) immunoelectrophoresis; 3) quantitative determination of immunoglobulins. The results were related to the degree of immunization as determined by Coombs indirect test on the mothers' serum and spectrophotometric curve of the amniotic fluid. For reasons of comparison, quantitative determination of immunoglobulins were performed on samples of amniotic fluid from 39 pregnant non-immunized patients. It was found that there was a direct relationship between antibody titers in the mothers' serum and those in the amniotic fluid, with the latter values always being inferior. Moreover, it was found that the level of IgG in the amniotic fluid and the degree of maternal immunization were proportional, with higher titers in the more severe cases. In addition to the routine tests, the determination of anti-Rh antibodies and titers of IgG in amniotic fluid can be useful in further evaluating degree of immunization in Rh-incompatibility. Furthermore, small quantities of IgA were found in amniotic fluid: these IgA were probably of secretory type (SIgA) and of amniotic origin, and therefore independent of any active immunization. Finally, all determinations of IgM were negative.

Amniocentesis↗