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PubMed2002

Repeated severe neonatal hemolysis due to Rhesus isoimmunization in a pregnant woman.

Rhesus (Rh) isoimmunization presenting as severe neonatal hemolytic disease is rare in RhD negative primigravidas of Chinese ethnicity. We report the case of a 32-year-old pregnant Taiwanese woman, RhD negative, who gave birth vaginally to two RhD-positive full-term fetuses 6 years apart. Antenatal follow-up was uneventful and there was no obvious fetal-maternal hemorrhage except at the performance of amniocentesis at the 19th week of the first pregnancy without anti-D immune globulin prophylaxis. Although anti-D immune globulins were administered to the mother within 1 hour after each birth, both of the newborns had severe neonatal hemolysis refractory to phototherapy and were rescued by exchange transfusions. Both of the children were well at age 7-years-old and one-year-old respectively In conclusion, with suspicion of fetal-maternal hemorrhage in RhD-negative pregnancies post amniocentesis, serial monitoring of indirect Coombs titer with appropriate management is mandatory.

Adult↗
PubMedDate not supplied

Incidence of Rhesus isoimmunization in Rhesus-negative mothers in Ramadi, Iraq, in the mid-1990s.

This work was carried out in Ramadi, Iraq over the period 1993 to 1997. Of 487 rhesus (Rh)-negative mothers tested and followed up, 172 were primigravida, 1.7% of whom were Rh-isoimmunized. The frequency of isoimmunization increased with increasing number of pregnancies (4.9% for second pregnancies to 45.4% for fifth pregnancies). Comparison of our results with other earlier studies shows that the incidence of Rh-isoimmunization in our study was considerably greater than the others.

Female↗
PubMed1992

Underutilization of Rh prophylaxis in the emergency department: a retrospective survey.

STUDY OBJECTIVE: To determine the practice of emergency physicians with regard to the issue of Rh isoimmunization. DESIGN: A retrospective chart review. SETTING: A university-affiliated tertiary care hospital emergency department. TYPE OF PARTICIPANTS: Pregnant women presenting with a risk factor for Rh sensitization. MEASUREMENTS AND MAIN RESULTS: One hundred thirty-eight patient encounters were analyzed descriptively as to whether they were candidates for Rh immune prophylaxis, and if so, whether it was given. Most (68%) were hospitalized. Of those, all were Rh typed, but two patients were not given Rh immune globulin (RhIG) when indicated. Of those discharged from the ED, most (86%) were not Rh typed, and none was administered RhIG. CONCLUSION: This study demonstrates a need for increased attention to the potential for Rh isoimmunization in patients presenting to the ED.

Abortion, Spontaneous↗
PubMed1983

Amniotic fluid beta-endorphin and beta-lipotropin concentrations during the second and third trimesters.

Amniotic fluid beta-endorphin (beta-EP) and beta-lipotropin (beta-LPH) were measured by radioimmunoassay after silicic acid extraction and gel chromatographic separation of the two peptides in uncomplicated second-trimester and term pregnancies, in diabetic patients at term, and in pregnancies complicated by Rh-isoimmunization, premature labor, and intrauterine growth retardation. Furthermore, the lecithin/sphingomyelin (L/S) ratios as well as the dehydroepiandrosterone sulfate (DHEA-S) and cortisol levels were determined in most of the amniotic fluid specimens. Both the mean (+/- SE) beta-EP (65.3 +/- 9.1 fmol/ml) and beta-LPH (150 +/- 15.8 fmol/ml) concentrations were significantly higher in the 20 patients with normal pregnancies of 16 to 21 weeks' duration than those found in 21 patients with uncomplicated term pregnancies of 38 weeks' gestation, averaging 42.6 +/- 6.0 and 80.1 +/- 10.7 fmol/ml, respectively. The mean amniotic fluid beta-EP and beta-LPH concentrations measured in the latter subjects were similar to those observed in 23 diabetic patients with otherwise uncomplicated term pregnancies. The mean amniotic fluid beta-EP and beta-LPH levels found in the limited number of patients with Rh-isoimmunization (N = 9), premature labor (n = 8), and intrauterine growth retardation (n = 5) with pregnancies of 24 to 36, 24 to 36, and 34 to 38 weeks' gestation, respectively, were not significantly different from the mean amniotic fluid beta-EP and beta-LPH concentrations of uncomplicated term pregnancies. In all patients but those with Rh-isoimmunization, beta-EP concentrations exhibited a positive correlation with beta-LPH levels. However, the molar beta-LPH:beta-EP ratio was significantly lower at term than during the early second trimester. Neither beta-EP nor beta-LPH correlated with the amniotic fluid L/S ratio and only beta-LPH exhibited a significant inverse correlation with amniotic fluid DHEA-S. The latter was significantly higher in uncomplicated term than second-trimester pregnancies. These results confirm that immunoassayable beta-EP is present in amniotic fluid and declines toward term. These data demonstrate that immunoassayable beta-LPH is present in amniotic fluid and show a more pronounced decrease toward the end of pregnancy than beta-EP. Neither peptide, at least on account of the amniotic fluid levels, appears to be associated with fetal maturation. The physiologic significance of amniotic fluid beta-EP and beta-LPH and their possible role as markers of fetal response to stress remain to be elucidated.

Amniotic Fluid↗
PubMed1977

Triplet pregnancy and Rhesus isoimmunization.

A case of Rh isoimmunization complicating triplet pregnancy is reported and the rarity of the combination is noted. The management of Rh immunized pregnancy is review with particular reference to problems associated with plural pregnancy. The findings confirm earlier reports that fetal or placental influences as well as antibody titres determine the severity of erythroblastosis.

Adult↗
PubMed1989

Pulmonary phospholipids in amniotic fluid of pathologic pregnancies: relationship with clinical status of the newborn.

We evaluated phospholipids, C-peptide and cortisol levels in amniotic fluid of 203 pathologic pregnancies (63, class A, B and C diabetics; 11 class D, F and H diabetics; 44 preclampsia and 85 Rh-isoimmunization); the control group was 82 normal pregnant women. There was an acceleration of fetal pulmonary maturation in women with preclampsia and severe Rh-isoimmunization in class D, F and H diabetics (at 34 weeks gestation the incidence of mature surfactant (lecithin/sphingomyelin greater than or equal to 2.7 and presence of phosphatidyl-glycerol) in these groups was 30%, 50% and 100%, respectively, while it was zero in the control group). At 37 and 38 weeks only 44.4% of the class A, B and C diabetics had mature surfactant and there was a significant difference with respect to the control group (x2 = 4.9; p less than 0.05); C-peptide levels in these diabetics (class A, B and C) were higher than in controls (p less than 0.001); in pregnant women with accelerated fetal lung maturation they were lower. We demonstrated a close relationship between fetal pulmonary maturity and the type of surfactant in amniotic fluid, which was independent of gestational age.

Amniotic Fluid↗
PubMed1999

Late hyporegenerative anemia in neonates with rhesus hemolytic disease.

This study was conducted to determine the risk factors of the late hyporegenerative anemia in Rh-isoimmunized infants. Data on 36 infants with rhesus hemolytic disease were analyzed. The mean gestational age and birth weight were 36 +/- 1.3 weeks and 2837 +/- 403 grams respectively. Twenty-seven infants (75%) received between 2 and 8 intravascular intrauterine blood transfusions. Fourteen infants (39%) required simple packed red blood cell transfusions and 11 infants (31%) required exchange blood transfusion in the immediate postnatal period. Thirty infants (83%) developed late anemia and required blood transfusions at a mean postnatal age of 43.3 +/- 15.7 days. Sixty-four percent of infants who had exchange blood transfusions did not develop late anemia, while 92% of infants who did not require exchange blood transfusion developed late anemia, and the difference was statistically significant (P = 0.035). Serum erythropoietin levels were determined in 8 infants immediately before simple transfusion for late anemia. The media serum erythropoietin level was 21.2 mU/ml, ranging between less than 10 to 114.2 mU/ml. We conclude that late hyporegenerative anemia is common among Rh isoimmunized infants, regardless of the intravascular intrauterine transfusion. Exchange blood transfusion was associated with less occurrence of late anemia.

Anemia↗
PubMed1990

Laboratory evaluation of jaundice in newborns. Frequency, cost, and yield.

Neonates with hyperbilirubinemia commonly undergo a battery of laboratory tests. We used a computerized database and medical records to study the frequency, cost, and yield of these tests in 2443 infants born at the University of California, San Francisco, between 1980 and 1982. Four hundred forty-seven (18%) of the infants met standard criteria for "nonphysiologic" hyperbilirubinemia; the incidence varied from 9% in blacks to 31% in Asian infants. About 55% of these 447 infants received a $125 "hyperbilirubinemia workup." Hospital discharge diagnoses on all 447 hyperbilirubinemic infants were reviewed. In 214 (48%), no cause of the jaundice was identified. An additional 145 (32%) had a possible cause apparent from history, physical examination, or initial hematocrit determination. The only diagnosis made as a result of routine investigations of hyperbilirubinemia was possible ABO or Rh isoimmunization in 75 infants (17%). Nonphysiologic hyperbilirubinemia may be more common than previously reported. The recommended tests are expensive and rarely lead to diagnoses other than ABO or Rh isoimmunization. Their routine use should be reevaluated.

Cost-Benefit Analysis↗
PubMed1980

Amniotic fluid reverse triiodothyronine in normal and high risk pregnancies.

The authors have dosed by radioimmunoassay the rT3 concentrations in the amniotic fluid of 12 normal pregnant women and of 25 women with high risk pregnancies at the same period of gestation. The average of the rT3 concentrations in the amniotic fluid of pregnant women affected by diabetes mellitus, EPH gestosis and with foetal growth, retardation, are not different from those found in the control group. In the patients affected by Rh isoimmunization, the rT3 levels are remarkably higher than those found in the control group. The rT3 highest levels found in the amniotic fluid of pregnant women affected by Rh isoimmunization could be due. 1) to a decreased transformation of rT3 in rT2 for an accentuated alteration of the sulphydryl groups: 2) to a need of blocking the pathway's conversion of T4 in T3 (hormone with great catabolic effect) in these foetuses already presenting an accentuated catabolism for the chronic hemolytic enemy and for the severe hepatic alterations.

Amniotic Fluid↗