Obstet Gynecol. 2017 Aug;130(2):481-483. doi: 10.1097/AOG.0000000000002226.
Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. There is wide variation in prevalence rates of Rh D-negative individuals between regions, for example from 5% in India to 15% in North America (1). However, high birth rates in low prevalence areas means Rh hemolytic disease of the newborn is still an important cause of morbidity and mortality in countries without prophylaxis programs (1). In such countries, 14% of affected fetuses are stillborn and one half of live born infants suffer neonatal death or brain injury (1). The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 13-16% to approximately 0.5-1.8% (2, 3). The risk was further reduced to 0.14-0.2% with the addition of routine antepartum administration (2, 3). Despite considerable proof of efficacy, there are still a large number of cases of Rh D alloimmunization because of failure to follow established protocols. In addition, there are new data to help guide management, especially with regard to weak D phenotype women. The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization.
Rh D 同种免疫的预防和治疗进展一直是现代产科学的重大成功案例之一。不同地区 Rh D 阴性个体的患病率差异很大，例如在印度为 5%，在北美为 15%（1）。然而，低患病率地区的高出生率意味着在没有预防计划的国家，新生儿 Rh 溶血病仍然是发病和死亡的重要原因（1）。在这些国家，14% 的受影响胎儿为死产，活产婴儿中有一半会出现新生儿死亡或脑损伤（1）。在经济较发达国家，常规使用 Rh D 免疫球蛋白使得红细胞同种免疫的发生率降低。20 世纪 70 年代首次引入产后注射 Rh D 免疫球蛋白后，高危妊娠中同种免疫的发生率从约 13 - 16% 降至约 0.5 - 1.8%（2, 3）。加上常规产前注射后，风险进一步降至 0.14 - 0.2%（2, 3）。尽管有大量疗效证据，但由于未遵循既定方案，仍有大量 Rh D 同种免疫病例。此外，有新的数据可帮助指导管理，特别是对于弱 D 表型女性。本文档的目的是为 Rh D 同种免疫风险患者的管理提供循证指导。
