Time points and risk factors for RhD immunizations after the implementation of targeted routine antenatal anti-D prophylaxis: A retrospective nationwide cohort study.
anti-D
fetomaternal hemorrhage
immunization
prevention
risk factors
routine antenatal anti-D prophylaxis
Journal
Acta obstetricia et gynecologica Scandinavica
ISSN: 1600-0412
Titre abrégé: Acta Obstet Gynecol Scand
Pays: United States
ID NLM: 0370343
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
16
06
2021
received:
25
04
2021
accepted:
18
06
2021
pubmed:
23
6
2021
medline:
28
9
2021
entrez:
22
6
2021
Statut:
ppublish
Résumé
Targeted routine antenatal anti-D prophylaxis was introduced to the national prophylaxis program in Finland in late 2013. The aim of this study was to assess the incidence, time-points, and risk factors for Rhesus D immunization after the implementation of routine antenatal anti-D prophylaxis, in all women in Finland with antenatal anti-D antibodies detected in 2014-2017. In a nationwide population-based retrospective cohort study, the incidence, time-points, and risk factors of anti-D immunizations were analyzed. Information on antenatal screening was obtained from the Finnish Red Cross Blood Service database, and obstetric data from hospital records and the Finnish Medical Birth Register. The study included a total of 228 women (197 with complete data for all pregnancies). After the implementation of routine antenatal anti-D prophylaxis, the prevalence of pregnancies with anti-D antibodies decreased from 1.52% in 2014 to 0.88% in 2017, and the corresponding incidence of new immunizations decreased from 0.33% to 0.10%. Time-points for detection of new anti-D antibodies before and after 2014 were the first screening sample at 8-12 weeks of gestation in 52% vs 19%, the second sample at 24-26 weeks in 20% vs 50%, and the third screening at 36 weeks in 28% vs 32%. The incidence of new anti-D immunizations decreased as expected after the implementation of routine antenatal anti-D prophylaxis. True failures are rare and they mainly occur when the prophylaxis is not given appropriately, suggesting a need for constant education of healthcare professionals on the subject.
Substances chimiques
Rh-Hr Blood-Group System
0
Rho(D) Immune Globulin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1868-1875Subventions
Organisme : Grants from the Päivikki and Sakari Sohlberg Foundation
Organisme : Päivikki and Sakari Sohlberg Foundation
Organisme : Helsinki University Hospital Obstetrics Department Research Funding
Informations de copyright
© 2021 Nordic Federation of Societies of Obstetrics and Gynecology.
Références
Chilcott J, Lloyd-Jones M, Wight J, et al. A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are Rhesus-negative. BJOG. 2004;111:892-902.
Barnett D, Buckley B,Campbell C, et al. National Institute for Health and Clinical Excellence. Routine Antenatal Anti-D Prophylaxis for Women Who Are Rhesus D Negative. 2008; NICE Technology Appraisal Guidance 156. https://www.nice.org.uk/guidance/ta156. Accessed June 1, 2021.
Turner RM, Lloyd-Jones M, Anumba DOC, et al. Routine antenatal anti-D prophylaxis in women who are Rh(D) negative: meta-analyses adjusted for differences in study design and quality. PLoS One. 2012;7:e30711. https://doi.org/10.1371/journal.pone.0030711
Crowther C, Middleton P, McBain RD. Anti-D administration in pregnancy for preventing Rhesus alloimmunisation. Cochrane Database Syst Rev. 2013;(2):CD000020.
Engelfriet CP, Reesink HW, Judd WJ, et al. Current status of immunoprophylaxis with anti-D immunoglobin. Vox Sang. 2003;85:328-337.
Koelewijn JM, de Haas M, Vrijkotte TG, Bonsel GJ, Van der Schoot CE. One single dose of 200 microg of antenatal RhIG halves the risk of anti-D immunization and hemolytic disease of the fetus and newborn in the next pregnancy. Transfusion. 2008;48:1721-1729.
Clausen FB, Steffensen R, Christiansen M, et al. Routine noninvasive prenatal screening for fetal RHD in plasma of RhD-negative pregnant women - 2 years of screening experience from Denmark. Prenatal Diagn. 2014;34:1000-1005.
Tiblad E, Westgren M, Pasupathy D, Karlsson A, Wikman TA. Consequences of being Rhesus D immunized during pregnancy and how to optimize new prevention strategies. Acta Obstet Gynecol Scand. 2013;92:1079-1085.
Haimila K, Sulin K, Kuosmanen M, et al. Targeted antenatal anti-D prophylaxis program for RhD-negative pregnant women - outcome of the first two years of a national program in Finland. Acta Obstet Gynecol Scand. 2017;96:1228-1233.
Hendrickson JE, Delaney M. Hemolytic disease of the fetus and newborn: modern practice and future investigations. Transfus Med Rev. 2016;30:159-164.
Koelewijn J, de Haas M, Vrijkotte T, van der Schoot C, Bonsel G. Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis. BJOG. 2009;116:1307-1314.
Tiblad E, Wikman TA, Ajne G, et al. Targeted routine antenatal anti-D prophylaxis in the Prevention of RhD immunization - outcome of a new antenatal screening and prevention program. PLoS One. 2013;8:e70984.
Heino A, Vuori E, Kiuru S, Gissler M. Perinataalitilasto. Medical Birth Register. 2018; Finnish Institute for Health and Welfare. https://www.thl.fi. Accessed June 1, 2021.
White J, Qureshi H, Massey E, et al. Guideline for blood grouping and red cell antibody testing in pregnancy. Transfus Med. 2016;26:246-263.
McCauley CJ, Morris K, Maguire K. A review of maternal alloimmunization to RhD in Northern Ireland. Transfus Med. 2017;27:132-135.
Ramsey G. Inaccurate doses of Rh Immune globulin after Rh-incompatible fetomaternal hemorrhage. Arch Pathol Lab Med. 2009;133:465-469.
Kim YA, Makar RS. Detection of fetomaternal hemorrhage. Am J Hematol. 2012;87:417-423.
Badami KG, Parker J, Kenny A, Warrington S. Incidence of maternal sensitization to Rh(D) in Christchurch, New Zealand and reasons for prophylaxis failures. N Z Med J. 2014;127:40-46.
Dohmen SE, Veragen OJHM, Breuniss W, et al. Chapter 7. Genetic factors influencing anti-D immune response: HLA-DRB1*15 is associated with anti-D hyperimmunization. In: Dohmen SE. The Human Immune Response to Rh Antigens. University of Amsterdam; 2008:111-132. (PhD Thesis).
Bowman J. Rh-immunoglobulin: Rh prophylaxis. Best Pract Res Clin Haematol. 2006;19:27-34.
Serious Hazards of Transfusion. Anti-D Immunisation Reporting. https://www.shotuk.org/reporting/anti-d-immunisation-reporting/. Accessed December 1, 2020.
Toly-Ndour C, Huguet-Jacquot S, Mailloux A, et al. Rh disease prevention: the European Perspective. ISBT Science Series. 2021;16(1):106-118.
Tiblad E, Wikman A, Rane A, Jansson Y, Westgren M. Pharmacokinetics of 250 μg anti-D IgG in the third trimester of pregnancy: an observational study. Acta Obstet Gynecol Scand. 2012;91:587-592.