BMJ  2005;330:1255-1258 (28 May), doi:10.1136/bmj.330.7502.1255

Clinical review

Management of pregnancies with RhD alloimmunisation

Sailesh Kumar, consultant in fetal medicine1, Fiona Regan, consultant haematologist1

1 Centre for Fetal Care and Department of Haematology, Hammersmith Hospitals NHS Trust, Queen Charlotte's Hospital, Imperial College London, London W12 0HS

Correspondence to: S Kumar sailesh.kumar@imperial.ac.uk

The first 150 words of the full text of this article appear below.

Introduction

Pregnancies complicated by red cell alloimmunisation may result in fetal anaemia secondary to transplacental passage of maternal immunoglobulin G, which causes progressive fetal haemolysis. In severe cases the anaemic fetus develops ascites, subcutaneous oedema, and pleural and pericardial effusions (hydrops fetalis) and dies in the womb. Many different antibodies (anti-D, anti-Kell, anti-c, anti-E, etc) can cause haemolytic disease of the fetus and newborn. This review covers the management of pregnancies affected with RhD alloimmunisation. The principles of management are similar regardless of the type of antibody involved, although care needs to be taken with pregnancies complicated by Kell alloimmunisation, where antibody concentrations do not always correlate with disease severity.

We searched PubMed for up to date references on current advances in the treatment of RhD alloimmunisation. In addition, we used guidelines on antenatal care and prophylaxis from the websites of the National Institute for Clinical Excellence (NICE, www.nice.org.uk) and . . . [Full text of this article]

Pathophysiology

Immunoprophylaxis

Management

Timing of delivery

Outcome

Neonatal anaemia

Neurodevelopmental outcome

Other treatment modalities

Conclusions


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