Current Medicine Research and Practice (Jan 2013)
Success story of prevention and management of Rh(D)-isoimmunized pregnancy, foetus and newborn [Part I]
Abstract
Management of an Rh(D)-negative alloimmunized pregnant woman has been a major challenge in obstetrics ever since Landsteiner reported the association of this condition with haemolytic disease of the foetus and newborn. In the past five decades through an incremental progress on the clinical side regarding the pathophysiology, intrauterine evaluation of severity of haemolytic process in the foetus initially through amniocentesis and currently by non-invasive methods, the foetus can be treated successfully at a prehydropic stage through intrauterine blood transfusion and later for neonatal haemolytic anaemia in specialized centres. A dramatic fall was recorded in perinatal mortality due to isoimmunization (45/100,000 before 1969 to 1.6/100,000 in 1990 in the UK). Currently in specialized centres, most of these newborns can be saved without any long-term neurological sequelae. At the same time, introduction of anti-D immunoglobulin has played an important role by reducing the incidence of isoimmunized women from 16% to 0.8% if the guidelines for immunization are correctly followed. This review article traces some key milestones, followed by the pathophysiology of the condition and management of Rh-negative non-sensitized and sensitized pregnant women. The non-invasive monitoring technique for Rh(D)-isoimmunized women will be highlighted in detail as this alone has had a major impact in the early diagnosis of the affected foetus that is likely to require invasive monitoring and intrauterine transfusion.
