目的:本指南为预防妊娠期RhD同种免疫(等免疫)提供了建议,包括家长测试,常规产后和产前预防,和其他预防的临床适应症。用非典型抗原(D抗原除外)预防妊娠红细胞同种免疫,目前尚无免疫预防,本指南中没有提到。
方法:所有RhD阴性妊娠个体由于可能暴露于父系来源的胎儿RhD抗原而存在RhD同种免疫风险。
结果:常规产后和产前RhD免疫预防可降低产后6个月和随后妊娠RhD同种免疫的风险。
结果:本指南详细介绍了可能受益于Rho(D)免疫球蛋白(RhIG)免疫预防的孕妇人群。因此,那些不需要干预的人可以避免不利影响,而那些有同种免疫风险的人可能会减轻他们自己和/或胎儿的这种风险。
方法:有关使用RhIG的建议,通过Ovid搜索Medline和MedlineinProcess和通过Ovid搜索EmbaseClassic+Embase,使用试验和观察性研究搜索策略以及研究设计过滤器进行搜索。对于审判,Cochrane中央受控试验登记册,Cochrane系统评价数据库,还搜索了Ovid效果评论摘要数据库。从2000年1月至2019年11月26日搜索所有数据库。2000年之前发表的研究是从全国妇产科专业学会的灰色文献中获取的,杰出的专业期刊,和书目搜索。为此更新进行了系统审查的正式程序,如单独发表的系统综述手稿中所述。
方法:作者使用SOGC的改良等级方法对证据质量和建议强度进行了评估。见附录A(表A1的定义和A2的强和条件[弱]建议的解释)。
■本指南的预期使用者包括产前护理提供者,如产科医生,助产士,家庭医生,急诊室医生,和居民,以及注册护士和执业护士。
结论:最新的加拿大预防RhD同种免疫指南针对D变体,胎儿Rh型的cffDNA,并更新了有关RhIG管理时间的建议。
OBJECTIVE: This guideline provides recommendations for the prevention of Rh D alloimmunization (isoimmunization) in pregnancy, including parental testing, routine postpartum and antepartum prophylaxis, and other clinical indications for prophylaxis. Prevention of red cell alloimmunization in pregnancy with atypical antigens (other than the D antigen), for which immunoprophylaxis is not currently available, is not addressed in this guideline.
METHODS: All Rh D-negative pregnant individuals at risk for Rh D alloimmunization due to potential exposure to a paternally derived fetal Rh D antigen.
RESULTS: Routine postpartum and antepartum Rh D immunoprophylaxis reduces the risk of Rh D alloimmunization at 6 months postpartum and in a subsequent pregnancy.
RESULTS: This guideline details the population of pregnant individuals who may benefit from Rho(D) immune globulin (RhIG) immunoprophylaxis. Thus, those for whom the intervention is not required may avoid adverse effects, while those who are at risk of alloimmunization may mitigate this risk for themselves and/or their fetus.
METHODS: For recommendations regarding use of RhIG, Medline and Medline in Process via Ovid and Embase Classic + Embase via Ovid were searched using both the trials and observational studies search strategies with study design filters. For trials, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects via Ovid were also searched. All databases were searched from January 2000 to November 26, 2019. Studies published before 2000 were captured from the grey literature of national obstetrics and gynaecology specialty societies, luminary specialty journals, and bibliographic searching. A formal process for the systematic review was undertaken for this update, as described in the systematic review manuscript published separately.
METHODS: The authors rated the quality of evidence and strength of recommendations using the SOGC\'s modified GRADE approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
UNASSIGNED: The intended users of this guideline include prenatal care providers such as obstetricians, midwives, family physicians, emergency room physicians, and residents, as well as registered nurses and nurse practitioners.
CONCLUSIONS: An updated Canadian guideline for prevention of Rh D alloimmunization addresses D variants, cffDNA for fetal Rh type, and updates recommendations on timing of RhIG administration.
CONCLUSIONS: RECOMMENDATIONS.