Noninvasive approaches to the management of RhD hemolytic disease of the fetus and newborn

摘要

RhD hemolytic disease is caused by maternal immunization to the D antigen, followed by subsequent transfer of maternal immunoglob-ulin G (IgG) across the placenta resulting in immune lysis of fetal red blood cells (RBCs). Severe RhD disease is still a source of clinical concern despite the introduction of prophylactic RhD immune globulin, and even in developed countries such as the United States and the European Union, the incidence of maternal alloimmu-nization remains at 1 to 1.5 percent of at-risk D- women, due mainly to failures of adequate RhD immune globulin administration or occult antepartum transplacental hemorrhage. Some 10 percent of these immunized women have a baby severely affected in utero, and the management of such pregnant women requires intensive monitoring to identify which fetuses are at risk of hemolytic disease of the fetus and newborn (HDFN) and identifying the optimal time for intervention to avoid fetal anemia and the risk of hydrops fetalis#