Thorp John M
Maternal and Child Health, UNC Schools of Medicine and Public Health, Chapel Hill, North Carolina 27599-7570, USA.
Obstet Gynecol Surv. 2008 Feb;63(2):112-5. doi: 10.1097/OGX.0b013e31816016fc.
In the United States, trauma occurs in 6% to 7% of pregnancies. Its severity may range from critical injuries where the mother's life is at risk, to apparently minor injuries, which might not be associated with any worrisome symptoms. One of the risks associated with a traumatic event is fetomaternal hemorrhage--the transfer of fetal blood cells into the maternal circulation. If the maternal blood type is rhesus negative and the fetus is rhesus positive, even a small amount of blood can cause the mother to develop antibodies against the fetal Rho D antigen, thus becoming sensitized. In subsequent pregnancies, this can lead to hemolytic disease of the fetus or newborn, which, if severe, is associated with total body edema, hepatosplenomegaly and heart failure, and intrauterine death. Although there are no published studies specific to the US population, poor awareness of the risk of sensitization following trauma and underutilization of anti-RhD in the emergency department has been reported in countries such as Canada and the United Kingdom. This article reminds caregivers of the risk of rhesus sensitization following blunt trauma, in order that they can administer anti-RhD appropriately and hemolytic disease of the fetus or newborn can be prevented.
在美国，6%至7%的孕期女性会遭遇创伤。其严重程度不一，从危及母亲生命的重伤到看似轻微、可能未伴有任何令人担忧症状的损伤都有。创伤事件的风险之一是胎儿 - 母体出血，即胎儿血细胞进入母体循环。如果母亲的血型为Rh阴性而胎儿为Rh阳性，即使少量血液也会使母亲产生针对胎儿Rho D抗原的抗体，从而致敏。在后续妊娠中，这可能导致胎儿或新生儿溶血病，严重时会出现全身水肿、肝脾肿大、心力衰竭及宫内死亡。尽管没有针对美国人群的已发表研究，但在加拿大和英国等国家，已有报道称人们对创伤后致敏风险的认知不足，且急诊科对抗RhD的使用不足。本文提醒护理人员注意钝性创伤后Rh致敏的风险，以便他们能合理使用抗RhD，预防胎儿或新生儿溶血病。
