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Fetal death due to extreme maternal Rh immune augmentation.

A 19-year-old woman who denied previous transfusion or pregnancy delivered a stillborn RhO(D)-positive male fetus at 38 weeks' gestation. IgG antibodies with the specificities anti-Rh0(D), anti-rh"(E), anti-Jka, and anti-Yta were eluted from the fetal red blood cells. In the maternal serum, the antiglobulin titer of anti-Rh0(D) was 1:20,000 and the saline (IgM) titer was 1:1,024. Amniocentesis findings at 36 weeks had suggested only mild, if any, fetal hemolysis, but the stillborn infant showed signs of severe hemolytic disease with cardiac failure. This case appears to represent an unusual augmented immune response to fetal red blood cell antigens.

Adult↗
PubMed1998

[Antenatal treatment of maternal-fetal Rh incompatibility hemolysis disease].

OBJECTIVE: To study the effective antenatal treatment of maternal-fetal Rh incompatibility hemolysis disease to improve fetal outcome. METHODS: Besides therapy of plasmapheresis, the immune globulin intravenous infusion (IVIg) was added for antenatal treatment of fetal hemolysis disease due to Rh incompatibility. Every 7-20 days 10 g IVIg was administered according to the titer of Rh antibody in maternal serum. RESULTS: 5 Rh negative pregnant women with poor obsterical history were treated with this protocol. Total IVIg infusion was 12 times with an average of 2.4 times per case, and there was no side effects. Plasmapheresis was used 18 times totally with an average of 3.6 per case. There was no fetal death. All the five newborns underwent exchange transfusion and IVIg therapy, and all were survival. CONCLUSIONS: IVIg may enter fetal blood circulation via placenta, and adjust fetal immune ability to reduce the degree of fetal hemolysis.

Adult↗