[Clinical problems in Rh isoimmunization; case report].
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The authors examined in 37 pregnant women hospitalized on account of Rh incompatibility during the second and third trimester 71 serum specimens for levels of trophoblast specific beta 1-glycoprotein (SP1), using the method of simple radial immunodiffusion. In the group of 16 women with Rh incompatibility whose pregnancy terminated by delivery of a normal neonate, in 22% the SP1 levels were higher than 1.5 x the median value for the given gestation week (MoM). In 17 pregnancies where the foetus suffered from haemolytic disease the SP1 levels were higher than 1.5 MoM in 45% of the examined foetuses. Markedly elevated SP1 levels of 2.3 and 2.4 MoM were recorded in two pregnancies with hydrops of the foetus.
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Rh isoimmunization is a potentially preventable condition that occasionally is associated with significant perinatal morbidity or mortality. Disease severity may be assessed using the modalities described above and frequently, invasive techniques are required to determine the risk of severe disease. Doppler flow studies appear to offer accurate, noninvasive means of evaluating fetal risk, which may allow for a decrease in invasive diagnostic procedures. The Rh isoimmunized patient, managed by an experienced team, can anticipate a favorable pregnancy outcome.
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Massive fetomaternal hemorrhage has been associated with numerous risk factors and can occur spontaneously. The risk is probably greater when a woman who is Rh negative has an ABO-compatible fetus. We report the case of a gravid, A-negative unsensitized patient who came to the hospital at term complaining of decreased fetal movement over the previous 24 hours. During evaluation, the fetal heart rate was found to have decreased beat-to-beat variability and repetitive late decelerations, and the mother was delivered of a 3,005 gA-positive neonate (by cesarean section) with a hemoglobin level of 2.9 g/dL. An acid elution test showed 400 mL of fetal blood in the maternal circulation, and the patient received 23 ampules (6,900 micrograms) of Rh immune globulin postpartum. The patient's condition was observed for 156 days after delivery; she did not become sensitized to the Rh factor. A massive fetomaternal hemorrhage can occur without any antecedent risk factors, with a risk of subsequent morbidity to the neonate. Sensitization can be prevented by prompt administration of adequate amounts of Rh immune globulin.
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