Speiser P
Wien Med Wochenschr. 1983 Dec 31;133(23-24):595-604.
The medical history of hemolytic disease of the newborn (h. d. n.) due to Rh is reviewed from 1928-1963 and a very common and widespread error in the international literature on statistical data of h. d. n. has been critically analysed and corrected on the basis of the Viennese material over a period of 25 years. It is shown the first time that the morbidity is not as high as 6 to 7 in 1000 newborns but approximately 3 to 4 taking into account the origin of their mothers. The frequency of h. d. n. in Vienna is strongly influenced by mothers who come from abroad with and without foreign citizenship. In 13,34% of h. d. n. the women produce Rh antibodies during pregnancy, and therefore the Rh prophylaxis given after birth is not able to prevent the immunization which means that 0,55 per thousand of the h. d. n. rate of 4,1 per thousand is caused by Rh antibodies developed intra graviditatem and 3,55 per thousand post partum. These figures are derived from observations between 1948 and 1971 in the Pre-Prophylaxis-Time. The success of the Anti-D-IgG application dropped the h. d. n. rate from 4,1 per thousand to 1,7 per thousand in 1981. If the figure of 0,55 per thousand is taken into account as a wrong "failure" of the post partum prophylaxis, 1,15 per thousand (1,7-0,55) of h. d. n. have to be noted as true failures. There are many causes possible for the high rate of failure in the post partum prophylaxis which is to be eliminated before one could think of a systematic ante partum Rh prophylaxis. In our population 17% are Rh negative, 10% of all mothers are Rh negative giving birth to a Rh positive child and 3,5 per thousand of mothers of h. d. n. develop Rh antibodies post partum, 0,55 per thousand before. Out of 1000 Anti-D-IgG injections given after birth 965 are without any consequence and therefore only 35 are effective. Making use of the ante partum prophylaxis (mother Rh negative, baby's Rh factor unknown) 17% of all pregnant women have to be treated for prevention of only 0,55 per thousand h. d. n. and only 3 injections of 1000 Anti-D-doses are of preventive value whereas 997 are useless.
回顾了1928年至1963年期间因Rh血型导致的新生儿溶血病（HDN）的病史，并基于维也纳25年的资料，对国际文献中关于HDN统计数据中一个非常常见且普遍存在的错误进行了批判性分析和纠正。首次表明，考虑到母亲的来源，发病率并非高达每1000名新生儿中有6至7例，而是约为3至4例。维也纳HDN的发病率受来自国外、有无外国国籍母亲的强烈影响。在13.34%的HDN病例中，女性在孕期产生Rh抗体，因此出生后进行的Rh预防无法预防免疫，这意味着每千分之4.1的HDN发病率中，每千分之0.55是由孕期产生的Rh抗体导致的，每千分之3.55是产后产生的。这些数据源自1948年至1971年预防前时期的观察结果。1981年，应用抗D-IgG使HDN发病率从每千分之4.1降至每千分之1.7。如果将每千分之0.55视为产后预防的错误“失败”，那么每千分之1.15（1.7 - 0.55）的HDN病例应被视为真正的失败。产后预防失败率高有多种可能原因，在考虑系统性产前Rh预防之前必须消除这些原因。在我们的人群中，17%为Rh阴性，所有母亲中有10%是Rh阴性且生育了Rh阳性孩子，每千分之3.5的HDN母亲产后产生Rh抗体，之前为每千分之0.55。出生后注射的1000剂抗D-IgG中，965剂没有任何效果，因此只有35剂有效。利用产前预防（母亲Rh阴性，婴儿Rh因子未知），所有孕妇中有17%必须接受治疗，只为预防每千分之0.55的HDN病例，1000剂抗D剂量中只有3剂具有预防价值，而997剂无用。
