这项审查的目的是系统地审查在流产的未敏感的恒河猴(RhD)阴性个体中常规抗D给药的结果。此评论已在Prospero注册。
搜索所有已发表和正在进行的研究,没有语言或出版状态的限制,从一开始就使用以下数据库进行:EBM评论Ovid-Cochrane中央对照试验登记册,MEDLINEOvid(Epub在打印前,过程中和其他非索引引文和每日),Embase.com,Popline和谷歌学者。研究类型包括:随机对照试验,对照试验,从1971年开始的队列和病例对照研究。人口包括接受堕胎的妇女(诱导,不完整,自发性或败血症流产),医疗或手术<12周,并在随后的怀孕中进行免疫接种。主要结果是:(1)Kleihauer-Betke试验阳性的发展和(2)在随后的妊娠中Rh同种免疫的发展。
共筛选了2652项研究,其中105项进行了全文审查。两项研究被纳入其中,并受到高度偏倚的赞赏。两项研究都发现,流产后很少有妇女对形成抗体敏感。可用的有限研究和异质性阻碍了荟萃分析的进行。
Rh免疫球蛋白具有良好的安全性。然而,它并非没有风险和成本,是提供高效服务的可能障碍,并且在某些国家/地区可能有限。目前研究的证据基础和质量有限。建议在妊娠早期进行Rh测试和免疫球蛋白给药的益处尚不清楚。随着临床实践指南的变化,需要更多的研究,基于专家的意见,并在堕胎时远离测试和管理。
妊娠早期Rh检测和免疫球蛋白给药的医学益处的证据有限。需要进一步的研究来定义同种免疫接种和免疫球蛋白益处,以更新护理标准。此外,在制定临床政策和指南时,应考虑其他因素,如成本,可行性和对患者获得护理的影响。
The aim of this
review was to systematically
review the outcome of routine anti-D administration among unsensitised rhesus (RhD)-negative individuals who have an abortion. This
review is registered with Prospero.
A search for all published and ongoing studies, without restrictions on language or publication status, was performed using the following databases from their inception: EBM Reviews Ovid - Cochrane Central Register of Controlled Trials, MEDLINE Ovid (Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily), Embase.com, Popline and Google Scholar. Study types included: randomised controlled trials, controlled trials, cohort and case-control studies from 1971 onwards. The population included women who undergo an abortion (induced, incomplete, spontaneous or septic abortion), medical or surgical <12 weeks, and isoimmunisation in a subsequent pregnancy. The primary outcomes were: (1) development of a positive Kleihauer-Betke test and (2) development of Rh alloimmunisation in a subsequent pregnancy.
A total of 2652 studies were screened with 105 accessed for full-text
review. Two studies have been included with high bias appreciated. Both studies found few women to be sensitised in forming antibodies after an abortion. The limited studies available and heterogeneity prevent the conduction of a meta-analysis.
Rh immunoglobulin has well-documented safety. However, it is not without risks and costs, is a possible barrier to delivering efficient services, and may have limited availability in some countries. The evidence base and quality of studies are currently limited. There is unclear benefit from the recommendation for Rh testing and immunoglobulin administration in early pregnancy. More research is needed as clinical practice guidelines are varied, based on expert opinions and moving away from testing and administration at time of abortion.
There is limited evidence surrounding medical benefit of Rh testing and immunoglobulin administration in early pregnancy. Further research is needed to define alloimmunisation and immunoglobulin benefit to update standards of care. Additionally, other factors should be considered in forming clinical policies and guidelines such as costs, feasibility and impact on access to care for patients.