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- Title
How clinically important are non-D Rh antibodies?
- Authors
Healsmith, Susan; Savoia, Helen; Kane, Stefan C.
- Abstract
<bold>Introduction: </bold>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.<bold>Material and Methods: </bold>This was a retrospective study of all pregnancies with non-D Rh antibodies (namely anti-C, -E, -c, -e, -Cw 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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
AUSTRALIA; VICTORIA; PRE-exposure prophylaxis; RED blood cell transfusion; PREGNANCY complications; IMMUNOGLOBULINS; WOMEN'S hospitals
- Publication
Acta Obstetricia et Gynecologica Scandinavica, 2019, Vol 98, Issue 7, p877
- ISSN
0001-6349
- Publication type
journal article
- DOI
10.1111/aogs.13555