TY - JOUR
T1 - Risk factors for RhD immunisation in a high coverage prevention programme of antenatal and postnatal RhIg
T2 - a nationwide cohort study
AU - Slootweg, Y. M.
AU - Zwiers, C.
AU - Koelewijn, J. M.
AU - van der Schoot, E.
AU - Oepkes, D.
AU - van Kamp, I. L.
AU - de Haas, M.
N1 - Funding Information: This study was conducted in partnership with Sanquin Diagnostics Amsterdam and Leiden University Medical Centre. This research was partly funded by a grant from Sanquin, Amsterdam, which did not influence design, conduct or publication of the study. Funding information Publisher Copyright: © 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2022/9
Y1 - 2022/9
N2 - Objective: To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations. Design: Prospective cohort study. Setting: The Netherlands. Population: Two-year nationwide cohort of alloimmunised RhD-negative women. Methods: RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined). Results: In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1–2.6), perinatal death (OR 3.5, 95% CI 1.1–10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2–16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1–3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0–9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001). Conclusion: Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
AB - Objective: To evaluate which risk factors for RhD immunisation remain, despite adequate routine antenatal and postnatal RhIg prophylaxis (1000 IU RhIg) and additional administration of RhIg. The second objective was assessment of the current prevalence of RhD immunisations. Design: Prospective cohort study. Setting: The Netherlands. Population: Two-year nationwide cohort of alloimmunised RhD-negative women. Methods: RhD-negative women in their first RhD immunised pregnancy were included for risk factor analysis. We compared risk factors for RhD immunisation, occurring either in the previous non-immunised pregnancy or in the index pregnancy, with national population data derived from the Dutch perinatal registration (Perined). Results: In the 2-year cohort, data from 193 women were eligible for analysis. Significant risk factors in women previously experiencing a pregnancy of an RhD-positive child (n = 113) were: caesarean section (CS) (OR 1.7, 95% CI 1.1–2.6), perinatal death (OR 3.5, 95% CI 1.1–10.9), gestational age >42 weeks (OR 6.1, 95% CI 2.2–16.6), postnatal bleeding (>1000 ml) (OR 2.0, 95% CI 1.1–3.6), manual removal of the placenta (MRP) (OR 4.3, 95% CI 2.0–9.3); these factors often occurred in combination. The miscarriage rate was significantly higher than in the Dutch population (35% versus 12.-5%, P < 0.001). Conclusion: Complicated deliveries, including cases of major bleeding and surgical interventions (CS, MRP), must be recognised as a risk factor, requiring estimation of fetomaternal haemorrhage volume and adjustment of RhIg dosing. The higher miscarriage rate suggests that existing RhIg protocols need adjustment or better compliance.
KW - alloimmunisation
KW - foetal medicine
KW - immunology
KW - screening
KW - serum
UR - http://www.scopus.com/inward/record.url?scp=85126524346&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/1471-0528.17118
DO - https://doi.org/10.1111/1471-0528.17118
M3 - Article
C2 - 35133072
SN - 1470-0328
VL - 129
SP - 1721
EP - 1730
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 10
ER -