Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2013 Dec;171(2):235-9. doi: 10.1016/j.ejogrb.2013.09.002. Epub 2013 Sep 8.
To determine the antenatal course of severe red cell alloimmunisation in pregnancies requiring intrauterine fetal transfusion.
A retrospective cohort study over 16 years in a single national quaternary fetal medicine centre. From 1996 to 2011, 242 red cell intrauterine transfusions (IUT) were performed in 102 alloimmunised pregnancies. Antibody type was categorized into Rh(D) and non-Rh(D) (including Rh(c), Kell and Rh(E)). Women with Rh(D) antibodies were further stratified into those with and without additional red cell antibodies. Data were compared using the Mann-Whitney U and Fisher's exact tests. Two-tailed P values at the 5% level were considered significant.
Comparing Rh(D) and non-Rh(D) pregnancies, there were no differences in either gestational age or fetal haemoglobin at first IUT, number of transfusions required, gestation at delivery, caesarean delivery rates or perinatal losses. In women sensitized to Rh(D), the presence of additional antibodies did not influence the degree of fetal anaemia or the first transfusion-delivery interval, although rates of fetal hydrops were higher in the presence of multiple antibodies. The "procedure-related" loss rate was 1.7% per procedure in our institution.
Antibody status does not appear to influence clinical outcomes following fetal transfusion for alloimmunisation.
确定需要宫内胎儿输血的严重红细胞同种免疫孕妇的产前病程。
在一个单一的国家四级胎儿医学中心进行了 16 年的回顾性队列研究。1996 年至 2011 年，102 例同种免疫孕妇中进行了 242 例红细胞宫内输血（IUT）。抗体类型分为 Rh（D）和非 Rh（D）（包括 Rh（c）、Kell 和 Rh（E））。Rh（D）抗体的妇女进一步分为有和无其他红细胞抗体的妇女。使用 Mann-Whitney U 和 Fisher 确切检验比较数据。双尾 P 值为 5%被认为具有统计学意义。
比较 Rh（D）和非 Rh（D）妊娠，首次 IUT 的胎龄或胎儿血红蛋白、所需输血次数、分娩时的胎龄、剖宫产率或围产儿丢失率均无差异。在对 Rh（D）致敏的妇女中，额外抗体的存在并不影响胎儿贫血的程度或首次输血-分娩间隔，尽管在存在多种抗体的情况下胎儿水肿的发生率更高。本机构的“与操作相关”的丢失率为每例操作 1.7%。
抗体状态似乎不会影响同种免疫胎儿输血后的临床结局。
