为了评估RhD免疫的风险因素仍然存在,尽管有足够的产前和产后常规RhIg预防(1000IURhIg)和额外的RhIg给药。第二个目标是评估RhD免疫接种的当前患病率。
前瞻性队列研究。
荷兰。
为期两年的全国同种免疫RhD阴性妇女队列。
首次RhD免疫妊娠的RhD阴性妇女被纳入危险因素分析。我们比较了RhD免疫的危险因素,发生在先前的非免疫妊娠或索引妊娠中,来自荷兰围产期登记(Perined)的国家人口数据。
在为期2年的队列中,来自193名女性的数据符合分析条件.先前经历过RhD阳性儿童怀孕的妇女(n=113)的重要危险因素是:剖腹产(CS)(OR1.7,95%CI1.1-2.6),围产期死亡(OR3.5,95%CI1.1-10.9),胎龄>42周(OR6.1,95%CI2.2-16.6),产后出血(>1000ml)(OR2.0,95%CI1.1-3.6),人工切除胎盘(MRP)(OR4.3,95%CI2.0-9.3);这些因素常同时发生.流产率显着高于荷兰人口(35%对12%。-5%,P<0.001)。
复杂的交付,包括大出血和手术干预的病例(CS,MRP),必须被视为风险因素,需要估计胎儿出血量和调整RhIg剂量。较高的流产率表明现有的RhIg方案需要调整或更好的依从性。
复杂分娩(剖腹产,人工去除胎盘,尽管产前和产后RhIg,但大出血)是RhD免疫接种的最有效危险因素。
To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations.
Prospective cohort study.
The Netherlands.
Two-year nationwide cohort of alloimmunised RhD-negative women.
RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined).
In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1-2.6), perinatal death (OR 3.5, 95% CI 1.1-10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2-16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1-3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0-9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001).
Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
Complicated delivery (caesarean section, manual removal placenta, major bleeding) is the most valid risk factor for RhD immunization despite antenatal and postnatal RhIg.