RESUMO
INTRODUCTION: The aim of the study is to analyse the benefit of rh-prophylaxis at the Universitäts-Frauenklinik Köln from 1967 to 1990. MATERIAL AND METHOD: During that period 28,761 births, of whom 2602 were non-sensitized rh-negative mothers with a rh-positive child (9.04%), were assessed. 2223 mothers received rh-prophylaxis, in 379 cases rh-prophylaxis was omitted particularly within the first 4 years of the study period, due to a limited provision of anti-D immunoglobulines. From 1972 onwards postnatal rh-prophylaxis was omitted in only 3%. In 14.5% of the 379 women without rh-prophylaxis contamination of the maternal circulation system with HbF cells was confirmed by the Kleihauer-Betke-Test. In 98.4% of the cases rh-prophylaxis was performed postnatally within the first 72 hours. RESULTS: During the study period the initial dosage of IgG anti-D was set at 55 - 150 microgram i.v. (n = 217) and later increased to 150 - 250 microgram i.v. (n = 1109) and finally to 300 - 330 microgram i.m. (n = 897). After rh-prophylaxis presence of HbF cells in the maternal circulation was found in 5.5% of the mothers of group 1, in 2.1% of the second group and in 1.1% of the third group. In the group of mothers without rh-prophylaxis 69 had a second delivery and rh-sensitsation was found in 7.3% of these cases. Of 537 women having received rh-prophylaxis who delivered a second rh-positive child, 9 (1.7%) showed rh-sensitisation. of the 352 women with rh-incompatibility 8 (2.3%) had already been sentisized during their first pregnancy. CONCLUSIONS: The study confirms that postnatal application of anti-D immunoglobulins is effective to a great extent but does however not completely exclude rh-sensitisation. Furthermore, we recommend the additional prenatal rh-prophylaxis as introduced by the German maternity regulations since 1990.
