Department of Obstetrics and Gynaecology, The University of Melbourne, The Royal Women's Hospital, Parkville, Victoria, Australia.
Pregnancy Research Center, Department of Maternal Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria, Australia.
Acta Obstet Gynecol Scand. 2019 Jul;98(7):877-884. doi: 10.1111/aogs.13555. Epub 2019 Feb 24.
The advent of RhD immunoglobulin prophylaxis to prevent maternal RhD alloimmunization has reduced the incidence of this condition and its associated poor outcomes. Consequently, non-D Rh antibodies now account for a greater proportion of alloimmunized pregnancies. These antibodies have been the subject of comparatively little research. This study investigated the incidence and clinical outcome of pregnancies affected by non-D Rh alloimmunization at an Australian tertiary maternity service.
This was a retrospective study of all pregnancies with non-D Rh antibodies (namely anti-C, -E, -c, -e, -C as well as the compound antibodies anti-CD, -cE and -ce) managed at the Royal Women's Hospital, Victoria, Australia, from 2009 to 2013 inclusive. Information collected included maternal demographics, details of the antibodies, course of the pregnancy and neonatal outcomes.
During the study period, 115 non-D Rh alloimmunized pregnancies were identified in 102 mothers. Forty-nine pregnancies reached the critical titer (> 16) from non-D Rh alone and 11 fetuses received intrauterine red blood cell transfusion. Labor was induced or cesarean section performed in 38 cases. Forty-three neonates were admitted to the special care nursery and 59 received phototherapy. Nine received treatment for anemia and 10 neonates received intravenous immunoglobulin.
Non-D Rh alloimmunization is a relatively uncommon complication of pregnancy, occurring in only .33% of pregnancies in the study period. It can lead to significant fetal/neonatal morbidity (and may lead to mortality). The most severe outcomes (including perinatal deaths) were mostly associated with the compound antibodies anti-CD and anti-cE, or a non-D Rh antibody in conjunction with anti-D.
RhD 免疫球蛋白预防措施的出现，预防了母体 RhD 同种免疫，降低了这种情况及其相关不良结局的发生率。因此，现在非 D 型 Rh 抗体在同种免疫妊娠中所占比例更大。这些抗体相对较少受到研究。本研究调查了澳大利亚一家三级产科服务机构中受非 D 型 Rh 同种免疫影响的妊娠的发生率和临床结局。
这是一项对 2009 年至 2013 年期间在澳大利亚维多利亚皇家妇女医院接受非 D 型 Rh 抗体（即抗 C、E、c、e、C 以及复合抗体抗 CD、cE 和 ce）治疗的所有妊娠的回顾性研究。收集的信息包括产妇人口统计学资料、抗体详细信息、妊娠过程和新生儿结局。
在研究期间，在 102 名母亲中发现了 115 例非 D 型 Rh 同种免疫妊娠。49 例妊娠的非 D 型 Rh 抗体滴度达到临界值（>16），11 例胎儿接受宫内红细胞输血。38 例分娩或剖宫产。43 例新生儿入住特护病房，59 例接受光疗。9 例接受贫血治疗，10 例新生儿接受静脉注射免疫球蛋白。
非 D 型 Rh 同种免疫是妊娠的一种相对罕见的并发症，在研究期间仅占妊娠的 0.33%。它可导致胎儿/新生儿严重发病（并可能导致死亡）。最严重的结局（包括围产儿死亡）主要与复合抗体抗 CD 和抗 cE 相关，或与抗 D 同时存在非 D 型 Rh 抗体相关。
