Grace Matthew R, Goodhue Brighton, Vora Neeta L
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Curr Opin Obstet Gynecol. 2025 Apr 1;37(2):55-59. doi: 10.1097/GCO.0000000000001011. Epub 2024 Dec 30.
Despite the availability of Rh(D) immune globulin (RhIg) to prevent alloimmunization in Rh(D)-negative pregnant patients, anti-Rh(D) alloimmunization remains a prevalent cause of hemolytic disease of the fetus and newborn (HDFN). Recent RhIg shortages have caused clinicians and professional societies to identify methods to prioritize RhIg administration. New cell-free DNA (cfDNA) tests to predict fetal red blood cell antigen genotypes have been proposed as an option to prioritize the administration of RhIg to Rh(D)-negative pregnant people.
Commercial laboratories offer fetal Rh(D) genotype testing as part of cfDNA screening for fetal aneuploidy. Studies indicate that these tests have a high sensitivity and specificity for the detection of fetal Rh(D) status. Considering the current RhIg shortage, the American College of Obstetricians & Gynecologists (ACOG) suggests that utilizing cfDNA tests to determine fetal Rh(D) status is a reasonable approach to prioritize RhIg administration when supply is limited.
cfDNA screening for fetal Rh(D) status is a reasonable approach to triage the administration of RhIg in the setting of the current RhIg shortage. Utilization of cfDNA screening for fetal Rh(D) and other red blood cell antigen status is likely to increase in routine care. Research, professional society guidance, and education are necessary to ensure well tolerated and equitable utilization.
尽管有Rh（D）免疫球蛋白（RhIg）可预防Rh（D）阴性孕妇发生同种免疫，但抗Rh（D）同种免疫仍然是胎儿和新生儿溶血病（HDFN）的常见原因。近期RhIg短缺促使临床医生和专业学会确定优先使用RhIg的方法。新的游离DNA（cfDNA）检测可预测胎儿红细胞抗原基因型，已被提议作为优先向Rh（D）阴性孕妇注射RhIg的一种选择。
商业实验室提供胎儿Rh（D）基因型检测，作为胎儿非整倍体cfDNA筛查的一部分。研究表明，这些检测对胎儿Rh（D）状态的检测具有高灵敏度和特异性。考虑到当前RhIg短缺的情况，美国妇产科医师学会（ACOG）建议，当供应有限时，利用cfDNA检测来确定胎儿Rh（D）状态是优先使用RhIg的合理方法。
在当前RhIg短缺的情况下，对胎儿Rh（D）状态进行cfDNA筛查是对RhIg给药进行分类的合理方法。在常规护理中，利用cfDNA筛查胎儿Rh（D）和其他红细胞抗原状态的情况可能会增加。需要开展研究、专业学会提供指导并进行教育，以确保其使用具有良好耐受性且公平合理。
