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Results for “Rh Isoimmunization”

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At least 955 records · Page 53Linked to original sources
PubMed2005

Prediction of fetal anemia in pregnancies with red-cell alloimmunization: comparison of middle cerebral artery peak systolic velocity and amniotic fluid OD450.

OBJECTIVE: To compare the accuracy of Doppler velocimetry (middle cerebral artery peak systolic velocity, MCA-PSV) and amniocentesis (amniotic fluid delta optical density 450 (OD450)) for the detection of fetal anemia against the gold standard of fetal blood sampling (FBS). METHODS: Thirty-eight pregnancies were identified to be at risk of fetal anemia from immune causes between January 2000 and May 2002. In a cross-sectional diagnostic accuracy study, MCA-PSV and amniotic fluid delta OD450 values were plotted on reference charts and compared to an FBS obtained within the subsequent 7 days. Receiver-operating characteristics (ROC) curves were used and the area under the curve (AUC) calculated to compare the overall accuracy of the two tests. Sensitivity, specificity and likelihood ratios for positive (LR+) and negative (LR-) test results were generated for specific thresholds of MCA-PSV and delta OD450. RESULTS: For MCA-PSV (n = 38), the AUC was 0.71 (95% CI 0.57-0.85) and for amniotic fluid delta OD450 (n = 22) it was 0.68 (95% CI 0.49-0.87) compared with FBS within 7 days. Sensitivity, specificity and LR+, LR- for MCA-PSV were 64%, 81%, 3.4 and 0.5, respectively, and 53%, 71%, 1.9 and 0.7 for amniotic fluid OD450, respectively. CONCLUSION: MCA-PSV and OD450 have similar test accuracy in detecting fetal anemia. MCA-PSV is non-invasive and therefore presents no risk of miscarriage or preterm labor and thus is a preferable method of screening for fetal anemia.

Amniocentesis↗
PubMed1995

IL-6 and G-CSF levels in amniotic fluid during the second trimester in normal and abnormal pregnancies.

Activity levels of cytokines were measured by stimulation of the cell lines NFS-60, 7TD1, and TF-1. In 39 samples of amniotic fluid, levels of Granulocyte-Stimulating Factor (G-CSF) were 1434 +/- 2063 (mean +/- SD) and of Interleukin (IL-6) 546 +/- 1071 pg/ml; Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) was not detectable. IL-6 was correlated to G-CSF (r = 0.3; p = 0.003). G-CSF (p = 0.0002) and IL-6 (p = 0.006) were influenced by Alpha-Fetoprotein (AFP) and G-CSF by rhesus-incompatibility (p = 0.0004). These findings suggest that cytokines such as IL-6 and G-CSF play some role in physiological and pathological pregnancy.

Adult↗
PubMed1991

Can high-dose immunoglobulin therapy be indicated in neonatal rhesus haemolysis? A successful case of haemolytic disease due to rhesus (c + E) incompatibility.

A male neonate with hyperbilirubinaemia and progressing anaemia due to rhesus (c + E) incompatibility received high dose intravenous gammaglobulin (ivIgG) therapy at 13 days of age. Clinical response to therapy was confirmed by a rapid decrease in serum bilirubin level, and with the prevention of a further decline of the haemoglobin level. No side-effects were noted. High dose ivIgG therapy could be an alternative to (exchange) blood transfusion in case of some haemolytic diseases of newborn.

Humans↗
PubMed1991

Haemolytic disease of the newborn infant. Long term efficiency of the screening and the prevention of alloimmunization in the mother: thirty years of experience.

During the last thirty years, the diagnosis, management and prevention of haemolytic disease of the newborn infant (HDN) have improved. From 1959 to 1988, 3004 HDN (ABO excluded) have been collected. The percentage of HDN with anti-D alloimmunization decreased significantly (98.4% from 1959 to 1968, 93.5% from 1969 to 1978 and 68.1% from 1979 to 1988). The anti-D HDN with exchange transfusion (ET) fell significantly between the first and second periods (577 versus 970; chi 2 = 19.92; P less than 0.001). On the other hand, the number of HDN other than anti-D increased during these three periods, but the percentage of these HDN which needed ET decreased. Our study shows the long term efficiency of the prevention of anti-D alloimmunization (since 1970) and of the irregular antibodies screening among all pregnant women (since 1979).

Antibodies, Anti-Idiotypic↗
PubMed1989

[Immunotherapy of couples with habitual abortion].

After habitual abortions and the exclusion of nonimmunological causes of miscarriage, 26 patients were treated with lymphocytes of their partners of prophylaxis of abortion. The first treatment was done during early pregnancy in eight patients. Of the remaining 18, 12 have become pregnant up to now. Five pregnancies have gone to term, one is in the 13th week at the moment, and five are in the 20th week. Two patients lost their baby after the 20th week due to nonimmunological causes. Again seven patients had an early spontaneous abortion. Thus, the success rate of the immunological therapy is 63.2% at the moment.

Abortion, Habitual↗
PubMedDate not supplied

The issue of anti-D: an integrated seamless approach from recognition of need to bedside administration.

BACKGROUND: The appropriate and timely administration of Anti-D immunoglobulin to Rhesus (D) negative women who have delivered Rhesus (D) positive babies is a vital part of obstetric care. Anti-D has an especially high profile in Ireland because of the tragic inadvertent transmission of Hepatitis C to Irish women in past decades. AUDIT: We have reviewed our policy and procedures pertaining to the administration of Anti-D for sensitising events during pregnancy and postnatally, in the Mid-Western Health Board in 1999/2000. As a result, major changes were made in the storage, issue, recording and administration of Anti-D. New procedures in the transfusion laboratory and in the maternity hospital have been accepted by scientists and midwives and supported by haematology and obstetric medical staff. The pharmacy and haematology laboratory no longer have a role in this programme. IMPLEMENTATION OF MULTI-DISCIPLINARY CHANGE MANAGEMENT: As a result of these changes, the storage, issuing and tracking of Anti-D has become the responsibility of the hospital blood bank. Measurement offoeto-maternal haemorrhage (FMH) is now the responsibility of bio medical scientists in blood bank, utilising both flow cytometry (increasingly recognised as the gold standard method) and the Kleihauer method (Kleihauer-Betke). The programme has moved from a doctor-administered IV Anti-D Ig, to a midwife-administered IM preparation. Prescription remains the responsibility of the doctor. These changes are facilitated by the protocol guided issue of the appropriate dose of Anti-D Ig by bio medical scientists to midwives. The issue of the Anti-D Ig occurs simultaneously with issue of results of mother and baby's serology testing and estimation of volume of FMH. These major changes have been guided by audit and needs assessment and require close liaison between medical, nursing and laboratory scientific staff in haematology, transfusion and obstetrics. CRITICAL INCIDENT AUDIT-CASE REPORT: Before new procedures became official policy, a critical incident audit allowed us to pilot our protocol and to revise it using draft new procedures. In this critical incident we describe successful management of a patient with a large foeto-maternal haemorrhage. This incident supported the need for the procedural enhancements already underway. This critical incident re-emphasised the need for the planned systems improvements to be introduced quickly.

Adult↗
PubMed2006

Rh alloimmunization: Doppler or amniotic fluid analysis in the prediction of fetal anemia?

OBJECTIVE: Compare the results of amniocentesis and those of middle cerebral artery peak systolic velocity to detect anemic fetuses in Rh alloimmunized pregnancies. METHOD: Descriptive observational study involving 99 consecutive Rh-negative pregnancies: 74 alloimmunized patients submitted to amniotic fluid spectrophotometry (group 1) and 25 alloimmunized cases managed with Doppler ultrasonography (group 2). Variables analyzed were the following: need for neonatal transfusion and neonatal hematocrit. RESULT: Neonatal hematocrit was significantly lower and the need for neonatal transfusion was significantly higher in cases managed with spectrophotometry compared to those managed with Doppler. CONCLUSION: Infants managed with Doppler velocimetry had higher hematocrit and less need for neonatal transfusion, suggesting that this non-invasive method of monitoring fetal anemia may best preserve the neonate.

Adolescent↗
PubMed1999

Rhesus disease: postnatal management and outcome.

The incidence of rhesus haemolytic disease has been markedly reduced. Affected infants who have had intrauterine transfusions suffer a late hyporegenerative anaemia. Postnatal haemolysis and hence treatment for hyperbilirubinaemia is less commonly needed. Optimal phototherapy reduces the need for postnatal exchange transfusions, but data on the efficacy of inhibitors of bilirubin production such as haem oxygenase inhibitors or immunoglobulin are less secure. Even hydropic infants have less than 20% mortality and bilirubin encephalopathy is uncommon. There is, however, very limited information on the long-term outcome of infants with rhesus haemolytic disease. Multicentre collaboration is required to test strategies to improve the management of affected individuals further and to provide meaningful data on their prognosis.

Blood Transfusion↗
PubMed1985

The nonstress test as a diagnostic test: a critical reappraisal.

In the past decade the nonstress test has become a major method of assessing high-risk pregnancy. Although many studies have been published, there has been a lack of rigorous adherence to the standard criteria for diagnostic testing, that is, presentation of test specificity, sensitivity, predictive value, and the prevalence of abnormal outcomes in the populations studied. Furthermore, the populations studied vary widely in composition, testing conditions, methods of test interpretation, and clinical management. The authors undertake a review of these studies, with a focus on these issues, in an attempt to indicate potential problems involved in current test usage and to suggest avenues for needed clinical investigation.

Evaluation Studies as Topic↗
PubMed1985

Alloimmunization in twin pregnancies.

Of 118 twins born of 59 alloimmunized mothers from 1944 to 1984, 65 were Rh-positive and six died. One twin in one of the 59 sets and four sets of twins referred from elsewhere underwent intrauterine fetal transfusion. The Manitoba twin and two pairs of the four referred sets survived. Fetal transfusions were begun at 22 2/7 and 24 1/7 weeks' gestation in one surviving set and 23 3/7 weeks in both twins of the other surviving set. Three twins of the four who died were hydropic at referral. There would have been a 62.5% chance of survival if they had been referred at 23 weeks' gestation. ABO incompatibility in one twin of three sets had no effect on the amelioration of severity of Rh disease. In three sets, gross hemoglobin disparities were due to twin-to-twin transfusion. Differences in degree of severity of disease in the other four dichorionic sets may have been due to differences in sex, Rh constitution, amount of fetal erythropoiesis, and fetal hepatocellular function.

ABO Blood-Group System↗
PubMed1986

Ultrasound-guided fetal intravascular transfusion in severe rhesus immunization.

The successful use of ultrasound-guided fetal umbilical venipuncture and direct intravascular transfusion in a case of severe hydrops fetalis at 28 weeks' gestational age is described. Complete reversal of the hydropic changes was observed in utero. The use of this new technique in fetal treatment of Rh disease is discussed.

Adult↗