engleski

Diagnosis and management of Rh alloimmunisation. A retrospective analysis of six years period

Objective. To assess the current problem of alloimmunisation in tertiary referral centre in Croatia. The obtained results were compared to published data worldwide. Methods. Retrospective case analysis including women with Rhesus (Rh) alloimmunisation treated in our Department from January 1997 to January 2003. Data of interest included incidence, prevention, diagnosis and treatment, with the final point on perinatal mortality and morbidity. Results. 23 pregnant women with alloimmunisation were identified. The incidence was 0.138% of deliveries in the same time period. The median gestational age at diagnosis/referral was 22 weeks ranging from 9 to 37 weeks. Anti D antigen, alone or in combination with the other antigens, was responsible for more than 90% of alloimmunisation cases included. Defined protocol for prevention of Rh D immunization after previous delivery was not properly followed in 9/19 cases. Particular problem was the prophylaxis after previous pregnancy termination (TOP) where only 1/14 woman received adequate prophylaxis and only after two of five TOP. Regarding fetal treatment, 9/23 women had totally 24 intrauterine intravascular blood transfusions (IUIVT). Overall, perinatal mortality was 13%, and median gestational age at delivery was 34 weeks ranging from 31 to 40 weeks. There was totally 31 fetal exchange transfusions after delivery performed in 14/20 newborns. Conclusion. Despite precise diagnostic criteria and modern therapeutic options, alloimmunisation remains problem in Croatia. It is still related to a high perinatal mortality and morbidity. The particular problem is inadequate prevention.

pregnancy; alloimmunisation; management; diagnosis; prevention; prophylaxis; treatment; outcome

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