Clinical case of unfavorable pregnancy outcome for the newborn in immunoincompatible pregnancy: difficulties of diagnosis and treatment
Michael M. Padrul , Ludmila M. Semyagina , Gulnara K. Sadykova , Igor Semyagin
Perm Medical Journal ›› 2019, Vol. 36 ›› Issue (3) : 91 -97.
Clinical case of unfavorable pregnancy outcome for the newborn in immunoincompatible pregnancy: difficulties of diagnosis and treatment
During the whole period of gestation, there occur complicated immunobiological mother-fetus relationships, which to a large extent determine further course of pregnancy and outcome for the newborn. Hemolysis of erythrocytes under the influence of antibodies,formed in mothers to fetal erythrocyte antigens, causes hemolytic disease of the fetus/newborn. The problem of hemolytic disease in immunoincompatible pregnancy,first of all in Rh-incompatibility, can’t be considered completely solved in this country,despite the achievements of perinatal medicine. The paper presents a clinical case of unfavorable perinatal pregnancy outcome in case of rhesus-immunization of the mother against the background of growing titer of highly agglutinable class of antibodies and unstable indices of maximum systolic speed in the medial cerebral artery (growth up to the zone “A” with successive fall to the zone “C”) without any other signs of fetal disorders available. This clinical case demonstrates actuality of the problem and difficulties in diagnosis of hemolytic disease of the fetus.
Pregnancy / rhesus-immunization / hemolytic disease of the fetus / delivery
| [1] |
Коноплянников А.Г., Павлова Н.Г. Изосерологическая несовместимость крови матери и плода. Гемолитическая болезнь плода и новорожденных. Акушерство: нац. руководство 2015; 324–334. |
| [2] |
Олина А.А., Садыкова Г.К., Галинова И.В. Структура репродуктивных потерь. Пермский медицинский журнал 2017; 34 (6): 59–61. |
| [3] |
«Резус-сенсибилизация. Гемолитическая болезнь плода: клинические рекомендации (протокол) № 15-4/10/2-3300 от 18.05.2017, available at: www.transtusion.ru/ 2017/08-09-2.pdf. |
| [4] |
Савельева Г.М., Коноплянников А.Г., Курцер М.А. Резус-иммунизация. Старые проблемы. Новые решения. Вопросы гинекологии, акушерства и перинатологии 2005; 4 (3): 89–93. |
| [5] |
Alshimmiri M.M. Prediction of fetal anemia by middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus isoimmunization. J Perinatol 2003; 23: 536–540. |
| [6] |
Avery’s neonatalogy: pathophysiology and management of the newborn. Ed. by M.G. Mac Donald, M.M.K. Seshia, M.D. Mullett. 6th ed. 2005; 1177–1181. |
| [7] |
Bowman J.M. Hemolytic disease (Erythroblastosis fetalis). Maternal-fetal medicine. 4th ed. Philadelphia: W.B. Saunders 1999; 736–767. |
| [8] |
Klumper J.F. Benefits and risks of fetal red-cell transfusion after 32 weeks gestation. Europ J Obst Gyn Reprod Biol 2000; 92: 91–96. |
| [9] |
Tynan J.A. Multiplexed analysis of circulating cell-free fetal nucleic acids for noninvasive prenatal diagnostic RHD testing. Am J Obstet Gynecol 2011; 204: 251. |
| [10] |
Valenti C. Endoamnioscopy and fetal biopsy: a new technique. Am. J. Obstet. Gynecol 1972; 114: 561–564. |
| [11] |
Vatsla D. et al. Treatment of fetal anemia in Rh-isoimmunized pregnancies with intrauterine fetal blood transfusion. J. Obstet. Gynecol. of India 2010: 60; 135–140. |
| [12] |
Yinon Y. et al. Early intrauterine transfusion in severe red blood cell alloimmunization. Ultrasound Obstet Gynecol 2010: 36; 601–606. |
Padrul M.M., Semyagina L.M., Sadykova G.K., Semyagin I.
/
| 〈 |
|
〉 |
PDF
