Hermann M, Kjellman H, Ljunggren C
Acta Obstet Gynecol Scand Suppl. 1984;124:1-15. doi: 10.3109/00016348409157011.
Anti-D immunoglobulin (250 micrograms) was given i.m. to 830 Rh-negative primigravidae and multigravidae round the 32nd to 34th week of gestation. The multigravidae had previously been treated with anti-D immunoglobulin post partum or after abortion and had been followed up serologically after 8 months. Five hundred and twenty-nine of the women delivered Rh-positive infants and received another injection of anti-D immunoglobulin (250 micrograms) within 72 hours of delivery. At the serological follow-up 8 months after delivery 2 women (0.4%) had weak anti-D antibodies by the papain technique. No anti-D could be detected in these 2 women 14 and 20 months, respectively, after delivery. In a previously performed postnatal clinical study with 250 micrograms anti-D immunoglobulin the failure rate was 1.6% (10 out of 645 women). Thus, antenatal prophylaxis significantly (p less than 0.05) reduced the incidence of Rh immunization. The haemoglobin and bilirubin levels in cord blood and capillary blood did not differ in the Rh-positive and Rh-negative infants. Three primiparae (0.2%) had anti-D antibodies at the time of the antenatal injection before delivery. Thus, the antenatal regimen of gestation did not give full protection from Rh immunization. It is suggested that an antenatal injection at the 28th week of gestation would have been more effective, as Rh sensitization during pregnancy has been reported to be more frequent from the 29th week of pregnancy. Since the introduction of postnatal anti-D prophylaxis the Rh immunization occurring during pregnancy accounts for most of the observed failures (2, 4, 5, 14, 20). The efficacy and safety of antenatal injection of anti-D immunoglobulin has therefore been investigated (5, 6, 7). At the Växjö Hospital in Sweden, where the incidence of anti-D antibodies was 1.6% (15), 250 micrograms of anti-D immunoglobulin were given at about 32-34 weeks of gestation from March, 1973, to December, 1977. The results are presented here.
在妊娠第32至34周左右，对830名Rh阴性初产妇和经产妇肌肉注射了250微克抗-D免疫球蛋白。这些经产妇此前在产后或流产后已接受过抗-D免疫球蛋白治疗，并在8个月后进行了血清学随访。其中529名妇女分娩出Rh阳性婴儿，并在分娩后72小时内又注射了一针250微克的抗-D免疫球蛋白。在分娩后8个月的血清学随访中，有2名妇女（0.4%）通过木瓜蛋白酶技术检测出弱阳性抗-D抗体。在分娩后14个月和20个月时，分别在这2名妇女体内未检测到抗-D抗体。在之前一项使用250微克抗-D免疫球蛋白进行的产后临床研究中，失败率为1.6%（645名妇女中有10名）。因此，产前预防显著（p<0.05）降低了Rh免疫的发生率。Rh阳性和Rh阴性婴儿脐带血和毛细血管血中的血红蛋白和胆红素水平没有差异。有3名初产妇（0.2%）在分娩前进行产前注射时就已存在抗-D抗体。因此，妊娠期间的产前方案并不能完全预防Rh免疫。有人建议在妊娠第28周进行产前注射可能会更有效，因为据报道妊娠期间的Rh致敏从妊娠第29周起更为频繁。自从引入产后抗-D预防措施以来，妊娠期间发生的Rh免疫占观察到的大多数失败病例（2、4、5、14、20）。因此，对产前注射抗-D免疫球蛋白的有效性和安全性进行了研究（5、6、7）。在瑞典韦克舍医院，抗-D抗体的发生率为1.6%（15），从1973年3月至1977年12月，在妊娠约32 - 34周时给予250微克抗-D免疫球蛋白。现将结果公布于此。
