1. Third trimester screening for alloimmunisation in Rhc-negative pregnant women: evaluation of the Dutch national screening programme.
- Author
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Slootweg, YM, Koelewijn, JM, Kamp, IL, Bom, JG, Oepkes, D, and Haas, M
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MATERNAL health , *PRENATAL care , *IMMUNOGLOBULIN analysis , *AMNIOCENTESIS , *BLOOD diseases , *BLOOD transfusion , *CHORIONIC villus sampling , *IMMUNOGLOBULINS , *ERYTHROBLASTOSIS fetalis , *MEDICAL screening , *THIRD trimester of pregnancy , *RH factor , *SURVIVAL , *DISEASE incidence , *SEVERITY of illness index , *PARITY (Obstetrics) , *RH isoimmunization , *EVALUATION of human services programs , *DIAGNOSIS , *THERAPEUTICS - Abstract
Objective: To evaluate the effect of red blood cell (RBC) antibody screening in the 27th week of pregnancy in Rhc-negative women, on detection of alloimmunisation, undetected at first trimester screening ('late' alloimmunisation), and subsequent haemolytic disease of the fetus and newborn (HDFN), to assess risk factors for late alloimmunisation.Design: Prospective cohort and nested case-control study.Setting: The Netherlands.Population: Two-year nationwide cohort.Methods: Prospective inclusion of Rhc-negative women with negative first trimester screening and of screen-negative controls. Assessment of incidence and numbers needed to screen (NNS) of late alloimmunisation and HDFN; logistic regression analysis to establish risk factors for late alloimmunisation.Main Outcome Measures: Late alloimmunisation, HDFN.Results: Late alloimmunisation occurred in 99 of 62 096 (0.159%) Rhc-negative women; 90% had c/E antibodies and 10% non-Rhesus antibodies. Severe HDFN (fetal/neonatal transfusion) occurred in two of 62 096 (0.003%) of Rhc-negative women and 2% of late alloimmunisations; moderate HDFN (phototherapy) occurred in 20 children [22.5%; 95% confidence interval (CI), 13.8-31.1%]. Perinatal survival was 100%. The NNS to detect one HDFN case was 2823 (31 048 for severe, 3105 for moderate HDFN). Significant risk factors were former blood transfusion [odds ratio (OR), 10.4; 95% CI, 1.14-94.9], parity (P-1: OR, 11.8; 95% CI, 3.00-46.5; P > 1: OR, 7.77; 95% CI, 1.70-35.4) and amniocentesis/chorionic villus sampling during current pregnancy (OR, 9.20; 95% CI, 1.16-72.9).Conclusions: Additional screening of Rhc-negative women improved the detection of late alloimmunisation and HDFN, facilitating timely treatment, with a NNS of 2823. Independent risk factors for late alloimmunisation were blood transfusion, parity and chorionic villus sampling/amniocentesis in the current pregnancy. The occurrence of most factors before the current pregnancy suggests a secondary immune response explaining most late alloimmunisations.Tweetable Abstract: Third trimester screening for alloimmunisation in Rhc-neg women improves detection and treatment of severe HDFN. [ABSTRACT FROM AUTHOR]- Published
- 2016
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