Maternal intravenous immunoglobulin: a non-invasive treatment option for Rhesus D-sensitised women with previous adverse pregnancy outcomes

Background. Maternal intravenous immunoglobulin (IVIG) may delay the onset and severity of fetal anaemia in Rhesus D (RhD)- sensitised pregnancies, thereby minimising the need for intrauterine transfusion and its associated complications. Objective. To compare the pregnancy outcomes of RhD-sensitised women who received antenatal IVIG with those who did not receive antenatal IVIG. Methods. This was a retrospective cross-sectional analysis of RhD-sensitised women who attended the Wits Fetal Medicine Centre (Johannesburg) from 1 January 2008 to 31 May 2018. Criteria for maternal IVIG administration were: (i) previous adverse pregnancy outcome (early neonatal death, intrauterine fetal death or miscarriage related to RhD sensitisation), (ii) women with high antibody titre levels (≥1:64) in the absence of fetal anaemia; and (iii) rising antibody titre levels. Maternal antibody titre levels, pregnancy and neonatal outcomes were compared in women who received IVIG v. those who did not receive IVIG. Results. Of the 42 RhD-sensitised women, 14 received IVIG. A greater proportion of women experienced a decrease in antibody titres in the IVIG v. no-IVIG group (43% v. 11%, respectively; p=0.04). Nine of the 10 women in the IVIG group with a previous adverse pregnancy outcome had a successful pregnancy outcome following IVIG treatment. Conclusion. Maternal IVIG may provide a successful pregnancy outcome in RhD-sensitised women with previous adverse pregnancy outcomes related to Rh disease, or women with raised or increasing maternal antibody titre levels who present in the first or early second trimester

Nuchal Translucency as a Method of First-Trimester Screening for Aneuploidy

Objective. To determine the effectiveness of nuchal translucency (NT) screening in predicting aneuploidy and structural abnormalities in a South African population. Study design. Descriptive study. Setting. Chris Hani Baragwanath Hospital fetal medicine unit. Outcome measures. An adjusted risk was derived from the combination of maternal age-related risk and the risk derived from NT screening. A positive screen was denoted by an adjusted risk of more than 1/300 and a negative screen by an adjusted risk of less than 1/300. In order to determine the number of undiagnosed abnormalities in the group; all babies were examined by a paediatrician at birth to detect and describe dysmorphic features. Results. A total of 428 patients underwent first-trimester screening between July 2003 and July 2005. Three per cent were lost to follow-up. Of the 415 patients analysed; 59 screened positive and 356 screened negative. The mean age for both groups of patients was 30.1 years. Of the 57 patients who screened positive; 24 elected to have chorionic villus sampling (CVS). This resulted in the detection of 6 chromosomal abnormalities and 2 structural abnormalities. Among the remaining 356 patients; who had screened negative; 2 had an increase in the adjusted risk when the risk was compared with the background risk; and 1 chromosomal abnormality was detected in this group; 8 elected to have CVS because of a previous history of a chromosomal abnormality; and there were no abnormalities among them. Conclusions. The use of these screening methods has enabled prenatal karyotyping to become cost effective; and allows concentration on pregnancies at highest risk for chromosomal abnormalities; regardless of age