背景:在过去的几十年中,妊娠相关的同种免疫和胎儿和新生儿溶血病(HDFN)的预防有了显着改善。考虑到HDFN护理的改善,本系统文献综述的目的是评估母亲和胎儿中Rh(D)和K介导的HDFN的产前治疗情况和结果,为了确定疾病的负担,为了找出文献中的证据空白,并为今后的研究提供建议。
方法:我们对MEDLINE进行了系统搜索,EMBASE和clinicaltrials.gov.观察性研究,试验,建模研究,队列研究的系统评价,和病例报告和系列妇女和/或其胎儿由恒河猴(Rh)D或Kell同种免疫引起的HDFN。提取的数据包括患病率;治疗模式;临床结果;治疗效果;和死亡率。
结果:我们确定了2,541篇文章。在排除2482篇文章并增加1篇文章进行系统评价筛选后,选择了60篇文章。大多数抽象数据来自病例报告和病例系列。Rh(D)和K介导的HDFN的患病率分别为0.047%和0.006%,分别。最常报告的产前治疗是宫内输血(IUT;中位频率[四分位距]:13.0%[7.2-66.0])。首次IUT的平均胎龄在25至27周之间。周。这个时机还早,有风险,在与IUT相关的结局中观察到。用IUT治疗的Rh(D)介导的HDFN妊娠中胎儿水肿的发生率为14.8%(范围,0-50%)和39.2%的K介导的HDFN。在19项研究中,总体平均±SD胎儿死亡率为19.8%±29.4%。出生时的平均胎龄在34至36周之间。
结论:这些发现证实了HDFN的稀缺性和经常需要宫内输血的固有风险,大多数分娩发生在早产晚期。我们发现了一些证据空白,为未来的研究提供了机会。
BACKGROUND: Prevention of pregnancy-related alloimmunization and the management of hemolytic disease of the fetus and newborn (HDFN) has significantly improved over the past decades. Considering improvements in HDFN care, the objectives of this systematic literature
review were to assess the prenatal treatment landscape and outcomes of Rh(D)- and K-mediated HDFN in mothers and fetuses, to identify the burden of disease, to identify evidence gaps in the literature, and to provide recommendations for future research.
METHODS: We performed a systematic search on MEDLINE, EMBASE and clinicaltrials.gov. Observational studies, trials, modelling studies, systematic reviews of cohort studies, and case reports and series of women and/or their fetus with HDFN caused by Rhesus (Rh)D or Kell alloimmunization. Extracted data included prevalence; treatment patterns; clinical outcomes; treatment efficacy; and mortality.
RESULTS: We identified 2,541 articles. After excluding 2,482 articles and adding 1 article from screening systematic reviews, 60 articles were selected. Most abstracted data were from case reports and case series. Prevalence was 0.047% and 0.006% for Rh(D)- and K-mediated HDFN, respectively. Most commonly reported antenatal treatment was intrauterine transfusion (IUT; median frequency [interquartile range]: 13.0% [7.2-66.0]). Average gestational age at first IUT ranged between 25 and 27 weeks. weeks. This timing is early and carries risks, which were observed in outcomes associated with IUTs. The rate of hydrops fetalis among pregnancies with Rh(D)-mediated HDFN treated with IUT was 14.8% (range, 0-50%) and 39.2% in K-mediated HDFN. Overall mean ± SD fetal mortality rate that was found to be 19.8%±29.4% across 19 studies. Mean gestational age at birth ranged between 34 and 36 weeks.
CONCLUSIONS: These findings corroborate the rareness of HDFN and frequently needed intrauterine transfusion with inherent risks, and most births occur at a late preterm gestational age. We identified several evidence gaps providing opportunities for future studies.