Jones P, McNay A, Walker W
Br Med J. 1969 Sep 27;3(5673):738-42. doi: 10.1136/bmj.3.5673.738.
A blind prospective survey of foeto-maternal bleeding in 200 primiparous pregnancies was carried out in an investigation of a possible association between foeto-maternal bleeding and hypertension in pregnancy. Evidence of foeto-maternal bleeding was found in 61% of 36 hypertensive pregnancies, and in 51% of 160 normotensive pregnancies, a difference which is not statistically significant.Significant differences between the hypertensive and the normotensive groups were found when foeto-maternal bleeding was related to gestation. In pregnancies that became hypertensive more foetal cells were found in the maternal circulation before week 36 than in normotensive pregnancies. In patients with oedema of the abdominal wall during pregnancy the incidence of foeto-maternal bleeding was significantly increased.These findings seem to explain why pre-eclamptic toxaemia is a significant predisposing factor in women who later develop Rh antibodies. It is recommended that anti-D gammaglobulin should be offered to all Rh-negative women with Rh-positive infants following a hypertensive pregnancy. Consideration should also be given to the question of administering anti-D gammaglobulin during Rh-negative hypertensive pregnancies if this procedure is proved to be both safe to mother and foetus and effective.The results provide contributory evidence that the placental vascular changes in toxaemic pregnancies precede the clinical signs and are not the result of hypertension.
为了研究胎儿-母体出血与妊娠期高血压之间可能存在的关联，对200例初产妇进行了一项关于胎儿-母体出血的盲法前瞻性调查。在36例高血压妊娠中，61%发现有胎儿-母体出血迹象；在160例血压正常的妊娠中，51%发现有此迹象，二者差异无统计学意义。当胎儿-母体出血与孕周相关时，高血压组和血压正常组之间存在显著差异。在妊娠36周前血压升高的孕妇中，其母血循环中发现的胎儿细胞比血压正常的孕妇更多。妊娠期间出现腹壁水肿的患者，胎儿-母体出血的发生率显著增加。这些发现似乎可以解释为什么先兆子痫是后来产生Rh抗体的女性的一个重要诱发因素。建议对所有Rh阴性且婴儿为Rh阳性的高血压孕妇给予抗D丙种球蛋白。如果证明该程序对母亲和胎儿既安全又有效，还应考虑在Rh阴性高血压妊娠期间给予抗D丙种球蛋白的问题。结果提供了补充证据，表明中毒性妊娠中的胎盘血管变化先于临床症状出现，而非高血压的结果。
