Changing trends in the management of red blood cell alloimmunization in pregnancy.

PROBLEM

Review the current management of red blood cell alloimmunization in pregnancy.

METHODS

Retrospective review of the literature and 8-year experience at Baylor College of Medicine, Houston, Tex.

RESULTS

Rhesus alloimmunization continues to affect one in 1000 pregnancies. Newly diagnosed disease can be managed with serial anti-human globulin titers until a critical value is achieved. Thereafter diagnostic modalities include ultrasound, amniocentesis, and percutaneous umbilical blood sampling. Patients with a history of a previously affected pregnancy should be managed in a more aggressive fashion. Newer methods of intravascular intrauterine transfusion can result in neonatal survival in more than 75% of cases. Long-term evaluation of these neonates indicates a good neurologic outcome.

CONCLUSIONS

New approaches to therapy using preimplantation diagnosis or selective suppression of the maternal immune system appear promising for the future.