Professional Documents
Culture Documents
Management
Dr. P. A. Awoyesuku
Dept. of Obs & Gynae
UPTH
Introduction
Major cause of perinatal mortality and a complete mystery before
the 1940s
Haemolytic disease continues to occur despite well organized
prophylaxis programmes
Care now given by specialized fetal medicine units
Perinatal mortality has therefore decreased 100-fold in the last 3
decades
Fetal disease varies from clinically insignificant to intrauterine fetal
death (IUFD) as early as 17 weeks
Management has improved in western countries as a result of
technical advances in the last decade
History / Diagnosis
Help to predict severity of haemolytic disease
– MATERNAL BLOOD TYPE / ANTIBODY SCREEN
Husband’s blood type
Husband’s zygosity
Mother’s antibody status
Antibody type – IgM or IgG
– 1:128 – 75%
wavelength – ΔOD450
The optical density is plotted on the standard Liley’s chart with Whitfield action line modification
Timing of amniocentesis depends on antibody titre and history of previously affected fetuses
First amniocentesis is generally performed 10 weeks prior to time of expected ominous event
If no downward trend, the ΔOD450 trend line on Liley’s curve is extrapolated until it crosses the
action line
– If this occurs <34weeks, fetal blood sampling is undertaken
NB: recently limit of 4Iu/mL has been challenged and an absolute level of ≥15 IU/mL has been
proposed as threshold for prenatal intervention
Liley’s chart
Percutaneous umbilical blood sampling
(Cordocentesis)
Can be performed under direct visualizaton (Fetoscopy) or indirect
degree of fetal anaemia ( Liley’s curve more predictive in 3rd than 2nd
trimester)
Ultrasound scan (USS)
Now mainstay of fetal monitoring and timing of first
intervention if anti-D level is ≥ 10 IU/mL
With anti-D levels > 4IU/mL fetus should be scanned
weekly from 18 weeks
Partner homozygous or fetus Rhesus positive – continue
weekly USS till you detect either fetal skin/scalp
oedema, ascites, pericardial or pleural effusion
Other USS features
– Polyhydramnios
– Fetal hepatosplenomegaly
– Cardiomegaly
– Placental hypertrophy
– Abnormal fetal posture (Buddha stance)
Treatment by fetal transfusion
When ΔOD450 falls in the highest zone after 34 weeks patient should be delivered
If < 34 weeks, an intrauterine transfusion is performed since the risk of transfusion is less than
risk of prematurity
Blood compatible with mothers blood is used; after the serum is depleted to a PCV of 90-95%
If sampled fetal PCV is below gestational reference range, fetus is usually transfused to a target
PCV of 50-55%
Second transfusion is always given 2 weeks after the first, which allows assessment of rate of fall
in PCV and change in percentage of fetal cells left in fetal circulation
These 2 factors determine timing of subsequent transfusions, usually given at 3-4 week intervals