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PubMed1977

Ovenstone Factor in the management of Rh sensitization.

Several methods have been developed for analyzing amniotic fluid to aid in the management of rhesus isoimmunization. Because all methods attempt to predict the severity of fetal hemolysis based on the original findings of Bevis and on the amount of unconjugated bilirubin in amniotic fluid as measured by its optical density at 450 millimicron, they share two possible sources of error: calculation of exact gestational age and accurately reading bloody or contaminated amniotic fluid. The Ovenstone Factor measures the derivative of the bilirubin curve against wavelength and thereby avoids some of the contaminating pigments at 450 millimicron. This paper compares the predictive accuracy of two methods, Liley versus Ovenstone Factor, in 78 samples of fluid from 46 patients. Predictions were correct in 80% of infants using Ovenstone Factor and 67% using the Liley curve, and incorrect in only 7% and 13%, respectively. The Ovenstone Factor, with its simplicity and high predictive accuracy, is an excellent additional tool in the management of Rh-sensitized pregnancies.

Amniotic Fluid↗
PubMed1995

Midtrimester Rh sensitization associated with circulating anticardiolipin antibodies and elevated maternal serum alpha-fetoprotein. A case report.

The incidence of antepartum Rh isoimmunization has been limited by third-trimester Rh immune globulin (RhIg) administration. Prophylactic failures are uncommon but can occur if sensitization takes place prior to the 28th week of gestation. We report a case of midtrimester Rh sensitization in an anticardiolipin antibody-positive primipara coincident with the discovery of an elevated maternal serum alpha-fetoprotein value, oligohydramnios and fetal growth retardation. This case suggests that fetal-maternal hemorrhage and subsequent sensitization may be facilitated by anticardiolipin antibody-induced placental damage. Prophylactic midtrimester RhIg administration might avoid sensitization in similar cases.

Adult↗
PubMed1995

Management of the Rh-sensitized mother.

The approval by the FDA of Rh immune globulin in 1968 led to a decrease in the incidence of Rh isoimmunization. As a result, fewer cases are seen by both the perinatologist and neonatologist. Prompt identification and early referral of the isoimmunized mother to a tertiary center will facilitate optimal management incorporating the latest techniques. In selected clinical situations, the less invasive technique of amniocentesis can be offered in place of fetal blood sampling for Rh D typing. In the anemic fetus requiring intrauterine transfusions, delivery is the goal once lung maturity is documented. As described elsewhere in the issue, recent improvements in neonatal care have facilitated management of complications not seen in the fetus but potentially critical in the neonate.

Anemia↗
PubMed1980

Rh sensitization after genetic amniocentesis.

A retrospective evaluation was undertaken of 78 Rh-negative women who underwent genetic amniocentesis without Rh-immune globulin prophylaxis. Of the 56 patients at risk for sensitization, 3 (5.4%) became sensitized during the pregnancy in which amniocentesis was performed. This number is not statistically different from the 2.1% incidence of spontaneous Rh immunization during pregnancy. However, a trend toward increasing sensitization after second-trimester amniocentesis was noted. As the fetoplacental blood volume at 16 weeks' gestation is approximately 12 to 13 ml, a 150-micrograms dose of Rh-immune globulin is recommended for the Rh-negative patient who is undergoing genetic amniocentesis.

Amniocentesis↗
PubMed1990

Fetal intestinal obstruction: necessity for percutaneous umbilical blood sampling to assess the severity of Rh sensitization.

Investigation into the severity of hemolytic disease due to Rh isoimmunization may be complicated by concurrent amniotic fluid contamination with bile. We have presented a case in which a prenatal sonogram showed evidence of fetal intestinal obstruction, which was subsequently confirmed postpartum by exploratory laparotomy. Since intrauterine regurgitation of bile occurs with intestinal obstruction distal to the papilla of Vater, percutaneous umbilical blood sampling is necessary to discern the presence and severity of hemolytic disease as indicated by an abnormal spectrophotometric absorption pattern.

Adult↗