Gottvall T, Hildén J O, Selbing A
Department of Obstetrics & Gynecology, University Hospital, Linköping, Sweden.
Acta Obstet Gynecol Scand. 1994 Apr;73(4):300-6. doi: 10.3109/00016349409015767.
During the time period 1983-90, 91,300 consecutive pregnancies were monitored for red cell alloimmunization. Once revealed, the immunizations were followed by means of repeated maternal antibody titers, maternal anti-D quantitation in D-immunized women, amniotic fluid bilirubin levels and fetal hemoglobin concentrations. High dose intravenous immunoglobulin and/or intrauterine intravascular transfusion was given to prevent or treat fetal anemia. Delivery was induced for all before term when antibody titers were > or = 16. Nevertheless, exchange transfusions were performed in 41 newborns with mothers alloimmunized to Rh(D), Rh(c), Rh(E) and Kell antigens. Eight of the mothers were Rh(D) positive. Phototherapy alone was given to 35 newborns. Both maternal antibody titers and amniotic fluid bilirubin levels were found to be unreliable to predict the need of exchange transfusions in the newborns. Quantitation of maternal anti-D concentration was found to be significantly better predicting 62% at a cut-off level of 0.7 microgram/mL. Analysis of fetal hemoglobin concentration by cordocentesis is the only direct method to evaluate the degree of fetal affection, and should probably be performed when maternal antibody titers are > or = 64, anti-D concentration is > or = 0.7 microgram/mL and data indicate an aggravation of the immunization.
在1983年至1990年期间，对91300例连续妊娠进行了红细胞同种免疫监测。一旦发现免疫情况，便通过重复检测母体抗体滴度、对D免疫的女性进行母体抗-D定量、检测羊水胆红素水平和胎儿血红蛋白浓度来跟踪。给予高剂量静脉注射免疫球蛋白和/或宫内血管输血以预防或治疗胎儿贫血。当抗体滴度≥16时，对所有孕妇均在足月前引产。然而，对41例母亲对Rh(D)、Rh(c)、Rh(E)和Kell抗原同种免疫的新生儿进行了换血治疗。其中8位母亲为Rh(D)阳性。仅对35例新生儿进行了光疗。发现母体抗体滴度和羊水胆红素水平均无法可靠地预测新生儿是否需要换血治疗。发现母体抗-D浓度定量在截断水平为0.7微克/毫升时预测效果明显更好，准确率为62%。通过脐血穿刺分析胎儿血红蛋白浓度是评估胎儿受影响程度的唯一直接方法，当母体抗体滴度≥64、抗-D浓度≥0.7微克/毫升且数据表明免疫情况加重时，可能应进行此项检查。
