Control of haemolytic disease of the newborn.

The decline in the stillbirth and death rates from haemolytic disease of the newborn in England and Wales between 1961 and 1973 is examined. The possible causes for this decline are identified and data related to each are assembled. The effects of intrauterine transfusions, changes in the abortion law, and changes in the racial mix as well as changes in the incidence of toxaemia of pregnancy and caesarean section can probably be disregarded for this purpose. Two major factors are the change in the birth rank distribution of births in England and Wales and general improvements in the quality of perinatal and obstetric care. When the above factors are excluded the effects of the specific control programmes upon stillbirths are not easy to measure or even detect. They probably accounted for less than one-fifth of the total decline in stillbirths from haemolytic disease of the newborn, although probably a larger proportion of the decline in neonatal deaths. During the period concerned, the most effective component in reducing losses was probably in the care of affected live-born infants and the primary preventive programme played only a minor part. Nevertheless, its effects are now discernible and it is likely to play a larger part in subsequent years. The quantification and monitoring of the part played by the preventive programme may require more developed information systems than are at present avilable.