Scott J R, Beer A E, Guy L R, Liesch M, Elbert G
Obstet Gynecol. 1977 Jan;49(1):9-14.
Rh immunization occurring during a first pregnancy with no history of preceding abortion or transfusion may result when Rh incompatible fetal to maternal bleeding ensues early enough in the gestation to initiate a maternal immune response before parturition. Alternatively, the initial antigenic stimulus could be the consequence of maternal to fetal transfer of Rh-incompatible erythrocytes while the patient herself was in utero or at the time of her own delivery. These hypotheses were tested by 1) analysis of the blood group and Rh of 22 Rh-immunized primigravidas, their infants, and their own mothers; 2) comparison of the number of fetal cells in the maternal circulation during the antepartum period in 20 women at high risk for fetal to maternal bleeding with their matched controls; and 3) Rho (D) antibody determinations in 70 Rh-negative infants born to Rh-positive mothers. The results indicate that antepartum fetal to maternal bleeding is the usual cause of Rh immunization in primigravidas, and the Rh-negative woman with blood group A, B, or AB who gestates an ABO-compatible Rh-positive male is at highest risk. The antepartum use of anti-Rho (D) immune globulin has potential prophylactic value in this situation.
在首次妊娠且无既往流产或输血史的情况下发生的Rh免疫，可能是由于在妊娠期足够早的时候发生了Rh血型不相容的胎儿-母体出血，从而在分娩前引发了母体免疫反应。或者，最初的抗原刺激可能是患者自身在子宫内或分娩时Rh血型不相容的红细胞从母体转移到胎儿的结果。通过以下方式对这些假设进行了检验：1）分析22名Rh免疫的初产妇、她们的婴儿以及她们自己母亲的血型和Rh血型；2）比较20名有胎儿-母体出血高风险的女性在产前期间母体循环中胎儿细胞数量与其匹配的对照组；3）对70名Rh阳性母亲所生的Rh阴性婴儿进行Rho（D）抗体测定。结果表明，产前胎儿-母体出血是初产妇Rh免疫的常见原因，而血型为A、B或AB型且怀有ABO相容的Rh阳性男性胎儿的Rh阴性女性风险最高。在这种情况下，产前使用抗Rho（D）免疫球蛋白具有潜在的预防价值。
