Ness P M, Baldwin M L, Niebyl J R
Am J Obstet Gynecol. 1987 Jan;156(1):154-8. doi: 10.1016/0002-9378(87)90228-6.
During a 5-year period, an enzyme-linked antiglobulin test was used to screen and quantitate fetal-maternal hemorrhage in 789 consecutive D-negative mothers who were delivered of D-positive babies. Six hundred seventy-two patients (85.2%) had no detectable fetal-maternal hemorrhage, and 117 patients (14.8%) had a detectable fetal-maternal hemorrhage. Eight of the 789 (1%) had a fetal-maternal hemorrhage greater than 30 ml and required more than one vial of Rh immune globulin. Two patients with fetal-maternal hemorrhage of 29 and 30 ml also received additional Rh immune globulin. Each case was reviewed for the presence of high-risk features that are thought to predict patients at risk for fetal-maternal hemorrhage. Patients having a cesarean section or complicated vaginal delivery were considered to be in a group at high risk for fetal-maternal hemorrhage, while those with a spontaneous vaginal delivery were considered not to be at risk for fetal-maternal hemorrhage. Thirty-two of 237 patients (13.5%) in the risk group and 82 of 552 patients (15.3%) in the group not at risk had detectable fetal-maternal hemorrhage. The incidence of fetal-maternal hemorrhage for these two groups was not statistically different (p greater than 0.50 by chi 2 analysis). If only patients in the risk group had been screened for fetal-maternal hemorrhage, then five of 10 (50%) who required more than one vial of Rh immune globulin would have been undertreated and at risk for developing anti-D antibodies. In addition, newborn birth weight, Apgar scores, and hematocrits were examined for 13 cases of fetal-maternal hemorrhage of greater than or equal to 21 ml, and none of these characteristics could be used to predict patients at risk for fetal-maternal hemorrhage. Therefore, no maternal or newborn characteristics could be identified that would reliably predict patients at risk for fetal-maternal hemorrhage. We conclude that all D-negative patients with D-positive babies should continue to be screened for fetal-maternal hemorrhage to identify those patients requiring more than one vial of Rh immune globulin.
在5年期间，采用酶联抗球蛋白试验对789例连续分娩出D阳性婴儿的D阴性母亲进行胎儿 - 母体出血的筛查和定量分析。672例患者（85.2%）未检测到胎儿 - 母体出血，117例患者（14.8%）检测到胎儿 - 母体出血。789例中有8例（1%）胎儿 - 母体出血量超过30 ml，需要使用超过1瓶Rh免疫球蛋白。2例胎儿 - 母体出血量分别为29 ml和30 ml的患者也接受了额外的Rh免疫球蛋白。对每例病例进行了高危特征检查，这些特征被认为可预测有胎儿 - 母体出血风险的患者。剖宫产或复杂阴道分娩的患者被视为胎儿 - 母体出血高危组，而自然阴道分娩的患者被认为无胎儿 - 母体出血风险。高危组的237例患者中有32例（13.5%）检测到胎儿 - 母体出血，非高危组的552例患者中有82例（15.3%）检测到胎儿 - 母体出血。这两组胎儿 - 母体出血的发生率无统计学差异（χ²分析p大于0.50）。如果仅对高危组患者进行胎儿 - 母体出血筛查，那么需要使用超过1瓶Rh免疫球蛋白的10例患者中有5例（50%）会治疗不足，有产生抗 - D抗体的风险。此外，对13例胎儿 - 母体出血量大于或等于21 ml的病例检查了新生儿出生体重、阿氏评分和血细胞比容，但这些特征均不能用于预测有胎儿 - 母体出血风险的患者。因此，无法确定可靠预测有胎儿 - 母体出血风险患者的母体或新生儿特征。我们得出结论，所有分娩出D阳性婴儿的D阴性患者都应继续进行胎儿 - 母体出血筛查，以识别那些需要使用超过1瓶Rh免疫球蛋白的患者。
