The effectiveness of the organization and specific prevention of Rh-conflict during pregnancy

Abstract

AIM: The aim of the study was to evaluate the effectiveness of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.

MATERIALS AND METHODS: To achieve the goal, an algorithm for managing pregnancy in Rh-negative women was developed, complex antenatal and postpartum prophylaxis of primary isoimmunization with anti-Rh0(D) immunoglobulin was carried out, and its effectiveness was evaluated in 37 women who gave birth to Rh-positive newborns. If antibodies to the Rh0(D) antigen were not detected, then at 28 weeks pregnant women were administered human immunoglobulin anti-Rh0(D) at a dose of 1500 IU (300 μg). Anti-Rh0(D) antibody titer was monitored every 2–3 weeks before delivery. Mothers were re-introduced with human anti-Rh0(D) immunoglobulin at a dose of 1500 IU (300 μg) within 24–72 hours after the birth of an Rh-positive child. 6 months after delivery, the antibody titer to the Rh0(D) antigen was re-determined.

RESULTS: After the introduction of domestic human immunoglobulin anti-Rh0(D), side effects and allergic reactions were not registered. All 37 (100%) women were delivered at term, of which 7 (18.9%) were delivered abdominally. All newborns were born with an Apgar score of 8–9 without hemolytic disease. The titer of antibodies to the Rh0(D) antigen was negative in 24 (64.9%) women 6 months after delivery. 13 (35.1%) mothers had a post-vaccination antibody titer not higher than 1 : 2, which is allowed by the instructions for the anti-Rh0(D) human immunoglobulin preparation. They tested negative again 12 months after delivery.

CONCLUSION: The results of the study showed a rather high efficiency of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.

Keywords

antibody titer to Rh0(D) antigen / fetal hemolytic disease / human immunoglobulin anti-Rh0(D) / postpartum prophylaxis of rhesus isoimmunization / prenatal prophylaxis of rhesus isoimmunization / rhesus-conflict pregnancy / rhesus isoimmunization

References

[1] Konoplyannikov AG, Pavlova NG. Isoserological incompatibility of maternal and fetal blood. Hemolytic disease of the fetus and newborn. In: Savel’eva GM, Sukhikh GT, Serov VN, Radzinskiy VE, eds. Obstetrics. National leadership. 2nd edition, revised and enlarged. Moscow: GETAR-Media Publ.; 2015. P. 324–334. (In Russ.)

[2] Коноплянников А.Г., Павлова Н.Г. Изосерологическая несовместимость крови матери и плода. Гемолитическая болезнь плода и новорожденных. В кн.: Акушерство. Национальное руководство / Под ред. Г.М. Савельевой, Г.Т. Сухих, В.Н. Серова, В.Е. Радзинского. 2-е изд., перераб. и доп. М.: ГЭТАР-Медиа, 2015. С. 324–334.

[3] Konoplyannikov AG, Tetruashvili NK, Mikhailov AV, et al. Rh isoimmunization. Hemolytic disease of the fetus: clinical guidelines. Moscow: Ministry of Health of the Russian Federation Publishing House; 2020. 45 p. (In Russ.)

[4] Коноплянников А.Г., Тетруашвили Н.К., Михайлов А.В., и др. Резус-изоиммунизация. Гемолитическая болезнь плода: клинические рекомендации. М.: МЗ РФ, 2020. 45 с.

[5] Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 25th edition. McGraw-Hill Education/Medical; 2018. 1344 р.

[6] Cunningham F.G., Leveno K.J., Bloom S.L., et al. Williams Obstetrics. 25th edition. McGraw-Hill Education/Medical, 2018. 1344 р.

[7] Moise KJ Jr. Management of rhesus all immunization in pregnancy. Obstet Gynecol. 2008;112(1):164–176.

[8] Moise K.J. Jr. Management of rhesus all immunization in pregnancy // Obstet. Gynecol. 2008. Vol. 112, No. 1. P. 164–176.

[9] Kharkevich ON, Gerasimovich SA. Modern prenatal technologies to reduce reproductive losses in fetal hemolytic disease. ARS medika. 2012;(5):104–110. (In Russ.)

[10] Харкевич, О.Н., Герасимович С.А. Современные пренатальные технологии снижения репродуктивных потерь при гемолитической болезни плода // ARS медика. 2012. № 5. С. 104–110.

[11] White J, Qureshi H, Massey E, et al. British Committee for Standards in Hematology. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfus Med. 2016;26(4):246–263. DOI: 10.1111/tme.12299

[12] White J., Qureshi H., Massey E., et al. British Committee for Standards in Hematology. Guideline for blood grouping and red cell antibody testing in pregnancy // Transfus. Med. 2016. Vol. 26, No. 4. P. 246–263. DOI: 10.1111/tme.12299

[13] McBain RD, Crowther CA, Middleton P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. Cochrane database Syst Rev 2015;2015(9): CD000020. DOI: 10.1002/14651858.CD000020.pub3

[14] McBain R.D., Crowther C.A., Middleton P. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation // Cochrane database Syst. Rev. 2015. Vol. 2015, No. 9. Art. CD000020. DOI: 10.1002/14651858.CD000020.pub3

[15] Eklund J. Prevention of Rh immunization in Finland. A national study, 1969–1977. Acta Paediatr Scand Suppl. 1978(274):1–57.

[16] Eklund J. Prevention of Rh immunization in Finland. A national study, 1969–1977 // Acta Paediatr. Scand. Suppl. 1978. No. 274. P. 1–57.

[17] Bartch F, Kjellman H. Postpartum prophylaxis with 250 µg of anti-D. In: Kabi Scientific report. No. 79 99 023. Stockholm; 1979. Р. 112–123.

[18] Bartch F., Kjellman H. Postpartum prophylaxis with 250 µg of anti-D In: Kabi Scientific report. No. 79 99 023. Stockholm, 1979. Р. 112–123.

[19] Hermann M, Kjellman H, Ljunggren C. Antenatal prophylaxis of Rh immunization with 250 micrograms anti-D immunoglobulin. Acta Obstet. Gynecol. Scand. Suppl. 1984;124:1–15. DOI: 10.3109/00016348409157011

[20] Hermann M., Kjellman H., Ljunggren C. Antenatal prophylaxis of Rh immunization with 250 micrograms anti-D immunoglobulin // Acta Obstet Gynecol Scand Suppl. 1984. Vol. 124. P. 1–15. DOI: 10.3109/00016348409157011

[21] Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of hemolytic disease of the fetus and newborn. Transfus Med. 2014;24(1):8–20. DOI: 10.1111/tme.12091

[22] Qureshi H., Massey E., Kirwan D., et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of hemolytic disease of the fetus and newborn // Transfus. Med. 2014. Vol. 24, No. 1. P. 8–20. DOI: 10.1111/tme.12091

[23] Bennardello F, Coluzzi S, Curciarello G, et al. Recommendations for the prevention and treatment of hemolytic disease of the fetus and newborn. Blood Transfus. 2015;13(1):109–134. DOI: 10.2450/2014.0119-14

[24] Bennardello F., Coluzzi S., Curciarello G., et al. Recommendations for the prevention and treatment of hemolytic disease of the fetus and newborn // Blood Transfus. 2015. Vol. 13, No. 1. P. 109–134. DOI: 10.2450/2014.0119-14

[25] Ozherel’eva MA, Kravchenko EN, Vetrov VV, et al. Prevention of hemolytic disease of the fetus and newborn and its severe forms in Rh-conflict (literature review). Detskaya meditsina Severo-Zapada. 2015;6(3):42–48. (In Russ.)

[26] Ожерельева М.А., Кравченко Е.Н., Ветров В.В., и др. Профилактика гемолитической болезни плода и новорожденного и ее тяжелых форм при резус-конфликте (обзор литературы) // Детская медицина Северо-Запада. 2015. Т. 6, № 3. С. 42–48.

[27] Konoplyannikov AG, Sichinava LG, Latyshkevich OA, et al. Past, present and future of immunoprophylaxis of hemolytic disease of the fetus and newborn. StatusPraesens. Ginekologiya, akusherstvo, besplodny brak. 2019(2(55)):109–115. (In Russ.)

[28] Коноплянников А.Г., Сичинава Л.Г., Латышкевич О.А., и др. Прошлое, настоящее и будущее иммунопрофилактики гемолитической болезни плода и новорожденного // StatusPraesens. Гинекология, акушерство, бесплодный брак. 2019. № 2 (55). С. 109–115.

[29] Ermolova NV, Petrov YuA, Kosenko LB. Prevention of hemolytic disease in the fetus and newborn. Glavny vrach Yuga Rossii. 2022(2(83)):14–16. (In Russ.)

[30] Ермолова Н.В., Петров Ю.А., Косенко Л.Б. Профилактика гемолитической болезни у плода и новорожденного // Главный врач Юга России. 2022. № 2 (83). С. 14–16.

RIGHTS & PERMISSIONS

Eco-Vector