ABSTRACT
OBJECTIVES: To determine the longitudinal trends of middle cerebral artery peak systolic velocity (MCA PSV) in fetuses with mild or moderate hemolytic disease according to the need for postnatal therapy. DESIGN: Prospective cohort study. SETTING: University referral center. SAMPLE: Twenty-three fetuses from singleton alloimmunized pregnancies. METHODS: Serial measurements of MCA PSV were performed. After delivery, newborns were grouped by the need for postnatal management into mild hemolytic disease, which required no or only phototherapy (n = 14, group 1), and moderate hemolytic disease, where postnatal top-up or exchange transfusions were required (n = 9, group 2). MAIN OUTCOME MEASURES: Serial Doppler MCA PSV data transformed to multiples of the median, analyzed with linear regression and exponential models. RESULTS: We performed 83 measurements in group 1: 3-8 per fetus; mean GA at inclusion, 23 weeks and 65 measurements in group 2: 4-15 per fetus; mean GA at inclusion, 22 weeks. The estimated mean slopes of the MCA PSVs increased with the degree of postnatal therapy required (group 1: MCA PSV = 0.003 GA + 1.298; group 2: MCA PSV = 0.035 GA + 0.436). The relative average increments (RAI) were 4.7% and 7.1%, respectively. The two groups exhibited significant differences in mean slope and RAI (p<0.05). CONCLUSIONS: Fetuses that required postnatal transfusions due to hemolytic disease showed an enhanced progressive increase in MCA PSVs compared to those without transfusion requirement. This information might enable their identification during pregnancy.
Subject(s)
Blood Transfusion/methods , Fetal Diseases , Middle Cerebral Artery/diagnostic imaging , Adult , Blood Flow Velocity , Cohort Studies , Czech Republic , Disease Management , Early Diagnosis , Erythroblastosis, Fetal/diagnosis , Erythroblastosis, Fetal/physiopathology , Erythroblastosis, Fetal/therapy , Female , Fetal Diseases/diagnosis , Fetal Diseases/physiopathology , Fetal Monitoring/methods , Gestational Age , Humans , Infant, Newborn , Pregnancy , Prospective Studies , Severity of Illness Index , Statistics as Topic , Ultrasonography, Prenatal/methodsABSTRACT
OBJECTIVE: The aim of this review is to give comprehensive summary on alloimmunisation of non-RhD erythrocyte antibodies. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, University Hospital Ostrava, Department of Obstetrics and Gynecology, University Hospital Olomouc. SUBJECT AND METHOD: Based on literature analysis using database search engines PubMed, Google Scholar, Ovid and Proquest in field of non-RhD erytrocyte antibodies, there has been summarized up-to-date knowledge on irregular antibodies. CONCLUSION: Pregnant women alloimmunisation of non-RhD erythrocyte antigens gather importance in conjunction with relative increase of their occurence. Profylaxis is not possible. Although these erythrocyte antigens are able to induce antibody responce in mother and result in subsequent hemolytic disease of fetus and newborn. There are discussed most frequent non-RhD antibodies in the paper.
