Antepartum management of rhesus alloimmunisation. A literature review
DOI:
https://doi.org/10.18597/rcog.331Keywords:
rhesus alloimmunisation, Rh disease, foetal anaemia, DopplerAbstract
Introduction: rhesus alloimmunisation remains a common disease in Colombia in spite of universal immunisation having been implemented with immunoglobulin anti-D (Rho) for all susceptible pregnancies. Rh alloimmunisation is a condition requiring risk factors to be identified, all pregnancies to be suitably screened and timely referral to a maternal foetal medicine unit ensured to minimise foetal complications and provide foetal intervention as necessary.
Objective: this review was aimed at summarising the available data to provide the reader with tools helping to improve medical care by reviewing the exactitude of screening methods and early diagnosis and the effectiveness of non-invasive and invasive methods of treatment.
Methodology: the literature in PubMed, EBSCO, Ovid and Pro Quest databases was reviewed. Original papers, reviews, guidelines and bulletins published between 2000 and 2008 were included.
Results: antibody titres and middle cerebral artery Doppler were seen to be the screening tools usually used for identifying haemolytic anaemia in the foetus and neonates in Rh alloimmunisation. Rh alloimmunization treatment included close follow-up, intrauterine transfusion and timely delivery and prevention of Rh alloimmunisation by immunoglobulin anti-D (Rho).
Conclusion: knowledge of the disease will lead to early recognition of the risk factors and early diagnosis for identifying foetuses at risk which are susceptible to intrauterine therapy.
Author Biographies
Saulo Molina-Giraldo
Especialista en Medicina Materno-Fetal. Fellow Intervención Fetal Baylor College of Medicine - Texas Children’s Fetal Center. Director Unidad de Terapia, Cirugía Fetal y Fetoscopia, Clínica Colsubsidio. Especialista en la Unidad de Terapia Fetal, Hospital de San José, Bogotá (Colombia).
Kenneth J. Moise-Jr
Profesor de Gineco-obstetricia y Cirugía, Baylor College of Medicine – Miembro del Texas Children’s Fetal Center - Texas Children’s Hospital, Houston (Texas, EUA).
References
Reali G. Inadequate prophylaxis in anti-D immunisation. Blood Transfus 2008;6:169-70.
Moise KJ Jr. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol 2008;112:164-76.
van der Schoot CE, Hahn S, Chitty LS. Non-invasive prenatal diagnosis and determination of fetal Rh status. Semin Fetal Neonatal Med 2008;13:63-8.
Maciuleviciene R, Gaurilcikas A, Simanaviciute D, Nadisauskiene RJ, Gintautas V, Vaitkiene D, et al. Fetal middle cerebral artery Doppler velocimetry in cases of rhesus alloimmunization. J Matern Fetal Neonatal Med 2008;21:361-5.
Li Y, Finning K, Daniels G, Hahn S, Zhong X, Holzgreve W. Noninvasive genotyping fetal Kell blood group (KEL1) using cell-free fetal DNA in maternal plasma by MALDI-TOF mass spectrometry. Prenat Diagn 2008;28:203-8.
Moise KJ Jr. The usefulness of middle cerebral artery Doppler assessment in the treatment of the fetus at risk for anemia. Am J Obstet Gynecol 2008;198:161.e-4.
Cunningham FG, MacDonald P, Gant N, Leveno K, Gilstrap l, Hankins G, et al. Williams Obstetrics, 21st ed. New York: McGraw Hill; 2002.
Landsteneir K. Visitado en 2009 Ago 04. Disponible en: http://historiadelamedicina.org/blog/2006/06/14/karl-landsteiner-1868-1943.
Chérif-Zahar B, Mattéi MG, Le Van Kim C, Bailly P, Cartron JP, Colin Y. Localization of the human Rh blood group gene structure to chromosome region 1p34.3-1p36.1 by in situ hybridization. Hum Genet 1991;86:398-400.
Liley A. Intrauterine transfusion of foetus in haemolytic disease. Br Med J 1963;2:1107-9.
Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses. N Engl J Med 2000;342:9-14.
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 75: management of alloimmunization. Obstet Gynecol 2006;108:457-64.
Geifman-Holtzman O, Grotegut CA, Gaughan JP. Diagnostic accuracy of non invasive fetal Rh genotyping from maternal blood-a meta-analysis. Am J Obstet Gynecol 2006;195:1163-73.
Paravisini I, Morales J, Müller de ME, Bravo P. Aloinmunización por Rh: a propósito de un caso. Rev obstet ginecol Venezuela 2001;61:187-92.
Insunza Á, Carrillo J, Yamamoto M. ¿Amniocentesis seriada ó Vmax de la arteria cerebral media (ACM), en el manejo de la embarazada en riesgo de enfermedad hemolítica perinatal por isoinmunizacion Rh? Rev chil obstet ginecol 2008;73:286-9.
Gomez GW, Gutiérrez JC, De León JF. Plasmaféresis manual como tratamiento en pacientes Rh negativas sensibilizadas. Rev argent Transfus 1989;15:157-63.
Departamento Administrativo Nacional de Estadística -DANE. Visitado en 2009 Ago 12. Disponible en: http://www.dane.gov.co
Ministerio de Protección Social. Visitado en 2009 Ago 12. Disponible en: http://www.minproteccionsocial.gov.co/VBeContent/home.asp
Moise KJ Jr. Management of rhesus alloimmunization in pregnancy. Obstet Gynecol 2002;100:600-11.
Pirelli K, Pietz B, Johnson S, Pinder H, Bellissimo D. Molecular determination of RhD zygosity. Am J Obstet Gynecol 2006;195:S172.
Brown S, Kellner LH, Munson M, Yang Y, Klotzle B. Non-invasive prenatal testing: technical strategies to achieve testing of cell free fetal DNA (CFFDNA) RhD genotype in a clinical lab. Am J Obstet Gynecol 2007;197:S173.
Bianchi DW, Avent ND, Costa JM, van der Schoot CE. Noninvasive prenatal diagnosis of fetal Rhesus D: ready for Prime(r) Time. Obstet Gynecol 2005;106:841-4.
Berkley EM, Rappaport VJ, Hurley TJ. Discordant middle cerebral artery peak systolic velocity Doppler studies in a fetus with RhD alloimmunization. Obstet Gynecol 2007;110:493-5.
Howe DT, Michailidis GD. Intraperitoneal transfusion in severe, early-onset Rh isoimmunization. Obstet Gynecol 2007;110:880-4.
Oepkes D, Adama van Scheltema P. Intrauterine fetal transfusions in the management of fetal anemia and fetal thrombocytopenia. Semin Fetal Neonatal Med 2007;12:432-8.
Detti L, Mari G. Noninvasive diagnosis of fetal anemia. Clin Obstet Gynecol 2003;46:923-30.
Nagey D. Noninvasive diagnosis of fetal anemia by Doppler ultrasonography. The New England Journal of Medicine 2000;343:66.
Dukler D, Oepkes D, Seaward G, Windrim R, Ryan G. Noninvasive tests to predict fetal anemia: a study comparing Doppler and ultrasound parameters. Am J Obstet Gynecol 2003;188:1310-4.
van Kamp IL, Klumper FJ, Bakkum RS, Oepkes D, Meerman RH, Scherjon SA, et al. The severity of immune fetal hydrops is predictive of fetal outcome after intrauterine treatment. Am J Obstet Gynecol 2001;185:668-73.
Zimmerman R, Carpenter RJ, Durig P, Mari G. Longitudinal measurement of peak systolic velocity in the fetal middle cerebral artery for monitoring pregnancies complicated by red cell alloimmunisation: a prospective multicentre trial with intention-to-treat. BJOG 2002;109:746-52.
Mari G.Middle cerebral artery peak systolic velocity: is it the standard of care for the diagnosis of fetal anemia? J Ultrasound Med 2005;24:697-702.
Divakaran TG, Waugh J, Clark TJ, Khan KS, Whittle MJ, Kilby MD. Noninvasive techniques to detect fetal anemia due to red blood cell alloimmunization: a systematic review. Obstet Gynecol 2001;98:509-17.
Oepkes D, Seaward PG, Vandenbussche FP, Windrim R, Kingdom J, Beyene J, et al. Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med 2006;355:156-64.
Cosmi E, Mari G, Delle Chiaie L, Detti L, Akiyama M, Murphy J, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia resulting from parvovirus infection. Am J Obstet Gynecol 2002;187:1290-3.
Abel DE, Grambow SC, Brancazio LR, Hertzberg BS. Ultrasound assessment of the fetal middle cerebral artery peak systolic velocity: a comparison of the near-field versus far-field vessel. Am J Obstet Gynecol 2003;189:986-9.
Mari G, Abuhamad AZ, Cosmi E, Segata M, Altaye M, Akiyama M. Middle cerebral artery peak systolic velocity: technique and variability. J Ultrasound Med 2005;24:425-30.
Sallout BI, Fung KF, Wen SW, Medd LM, Walker MC. The effect of fetal behavioral states on middle cerebral artery peak systolic velocity. Am J Obstet Gynecol 2004;191:1283-7.
Bartha JL, Abdel-Fattah SA, Hunter A, Denbow M, Kyle P, Soothill PW. Optimal interval between middle cerebral artery velocity measurements when monitoring pregnancies complicated by red cell alloimmunization. Fetal Diagn Ther 2006;21:22-5.
Detti L, Oz U, Guney I, Ferguson JE, Bahado-Singh RO, Mari G, etal. Doppler ultrasound velocimetry for timing the second intrauterine transfusion in fetuses with anemia from red cell alloimmunization. Am J Obstet Gynecol 2001;185:1048-51.
Mari G, Zimmermann R, Moise KJ Jr, Deter RL. Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions. Am J Obstet Gynecol 2005;193:1117-20.
Scheier M, Hernández-Andrade E, Carmo A, Dezerega V, Nicolaides KH. Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol 2004;23:432-6.
Klumper FJ, van Kamp IL, Vandenbussche FP, Meerman RH, Oepkes D, Scherjon SA, et al. Benefits and risks of fetal red-cell transfusion after 32 weeks gestation. Eur J Obstet Gynecol Reprod Biol 2000;92:91-6.
Molina S, Alfonso D. Vigilancia fetal ante parto. Medicina Perinatal. Ed Panamericana. 2009. En prensa.
De Boer IP, Zeestraten EC, Lopriore E, van Kamp IL, Kanhai HH, Walther FJ. Pediatric outcome in Rhesus hemolytic disease treated with and without intrauterine transfusion. Am J Obstet Gynecol 2008;198:54 e1-4.
Trevett TN, Dorman K, Lamvu G, Moise KJ. Antenatal maternal administration of phenobarbital for the prevention of exchange transfusion in neonates with hemolytic disease of the fetus and newborn. Am J Obstet Gynecol 2005;192:478-82.
Vademecum PLM. Visitado en 2009 Ago 12. Disponible en: http://www.prvademecum.com/PRData/NEWPrincipioActivo.asp?D=285
Bowman JM. The prevention of Rh immunization. Transfus Med Rev 1988;2:129-50.
Bowman JM. Controversies in Rh prophylaxis. Who needs Rhimmune globulin and when should it be given? Am J Obstet Gynecol 1985;151:289-94.
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