Open AccessHow clinically important are non‐D Rh antibodies?
Author(s) -
Healsmith Susan,
Savoia Helen,
Kane Stefan C.
Publication year - 2019
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13555
Subject(s) - medicine , pregnancy , incidence (geometry) , obstetrics , retrospective cohort study , anemia , fetus , antibody , pediatrics , gestation , blood transfusion , immunology , surgery , genetics , physics , optics , biology
The advent of RhD immunoglobulin prophylaxis to prevent maternal RhD alloimmunization has reduced the incidence of this condition and its associated poor outcomes. Consequently, non‐D Rh antibodies now account for a greater proportion of alloimmunized pregnancies. These antibodies have been the subject of comparatively little research. This study investigated the incidence and clinical outcome of pregnancies affected by non‐D Rh alloimmunization at an Australian tertiary maternity service. Material and methods This was a retrospective study of all pregnancies with non‐D Rh antibodies (namely anti‐C, ‐E, ‐c, ‐e, ‐C w as well as the compound antibodies anti‐CD, ‐cE and ‐ce) managed at the Royal Women's Hospital, Victoria, Australia, from 2009 to 2013 inclusive. Information collected included maternal demographics, details of the antibodies, course of the pregnancy and neonatal outcomes. Results During the study period, 115 non‐D Rh alloimmunized pregnancies were identified in 102 mothers. Forty‐nine pregnancies reached the critical titer (> 16) from non‐D Rh alone and 11 fetuses received intrauterine red blood cell transfusion. Labor was induced or cesarean section performed in 38 cases. Forty‐three neonates were admitted to the special care nursery and 59 received phototherapy. Nine received treatment for anemia and 10 neonates received intravenous immunoglobulin. Conclusions Non‐D Rh alloimmunization is a relatively uncommon complication of pregnancy, occurring in only .33% of pregnancies in the study period. It can lead to significant fetal/neonatal morbidity (and may lead to mortality). The most severe outcomes (including perinatal deaths) were mostly associated with the compound antibodies anti‐CD and anti‐cE, or a non‐D Rh antibody in conjunction with anti‐D.