Cargando…

Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital

BACKGROUND: The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. METHODS:...

Descripción completa

Detalles Bibliográficos
Autores principales: Sánchez-Durán, María Ángeles, Higueras, María Teresa, Halajdian-Madrid, Cecilia, Avilés García, Mayte, Bernabeu-García, Andrea, Maiz, Nerea, Nogués, Nuria, Carreras, Elena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794826/
https://www.ncbi.nlm.nih.gov/pubmed/31615430
http://dx.doi.org/10.1186/s12884-019-2525-y
_version_ 1783459371711201280
author Sánchez-Durán, María Ángeles
Higueras, María Teresa
Halajdian-Madrid, Cecilia
Avilés García, Mayte
Bernabeu-García, Andrea
Maiz, Nerea
Nogués, Nuria
Carreras, Elena
author_facet Sánchez-Durán, María Ángeles
Higueras, María Teresa
Halajdian-Madrid, Cecilia
Avilés García, Mayte
Bernabeu-García, Andrea
Maiz, Nerea
Nogués, Nuria
Carreras, Elena
author_sort Sánchez-Durán, María Ángeles
collection PubMed
description BACKGROUND: The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. METHODS: This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. RESULTS: Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers < 1:16 (resulting in 38 livebirths), and 156 had titers ≥1:16 or anti-K antibodies. In the last group, 6 cases miscarried before 18 weeks, 93 had a MCA-PSV < 1.5 multiples of the median (MoM), resulting in 3 perinatal deaths that were unrelated to fetal anemia, one termination and 89 livebirths; and 57 had a MCA-PSV > 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p < 0.001), hydrops (p < 0.001) and early gestational age at first transfusion (p = 0.029) CONCLUSION: Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion.
format Online
Article
Text
id pubmed-6794826
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-67948262019-10-21 Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital Sánchez-Durán, María Ángeles Higueras, María Teresa Halajdian-Madrid, Cecilia Avilés García, Mayte Bernabeu-García, Andrea Maiz, Nerea Nogués, Nuria Carreras, Elena BMC Pregnancy Childbirth Research Article BACKGROUND: The aims of this study were to determine the prevalence of the different anti-erythrocytic alloantibodies, to describe pregnancy outcomes according to a low-risk and high-risk classification for fetal anemia and to determine the factors that influence adverse perinatal outcomes. METHODS: This retrospective observational study included women referred to our center following the identification of maternal anti-erythrocytic alloantibodies between 2002 and 2017. Pregnancies were classified as high risk for fetal anemia in cases with clinically significant antibodies, no fetal-maternal compatibility and titers ≥1:16 or any titration in cases of Kell system incompatibility. In high-risk pregnancies, maternal antibody titration and the fetal middle cerebral artery peak systolic velocity (MCA-PSV) were monitored. Low-risk pregnancies underwent routine pregnancy follow-up. RESULTS: Maternal antibodies were found in 337 pregnancies, and 259 (76.9%) of these antibodies were clinically significant. The most frequent antibodies were anti-D (53%) and anti-K (19%). One hundred forty-three pregnancies were classified as low risk for fetal anemia, 65 (25%) cases were classified as no fetal-maternal incompatibility, 78 had clinically nonsignificant antibodies, 4 (2.8%) resulted in first-trimester pregnancy loss, and 139 (97.2%) resulted in livebirths. Of the 194 high-risk pregnancies, 38 had titers < 1:16 (resulting in 38 livebirths), and 156 had titers ≥1:16 or anti-K antibodies. In the last group, 6 cases miscarried before 18 weeks, 93 had a MCA-PSV < 1.5 multiples of the median (MoM), resulting in 3 perinatal deaths that were unrelated to fetal anemia, one termination and 89 livebirths; and 57 had a MCA-PSV > 1.5 MoM, resulting in 3 intrauterine deaths, 6 terminations and 48 livebirths. Ninety-two intrauterine transfusions were performed in 45 fetuses (87% anti-D). Adverse outcomes were related to a MCA-PSV > 1.5 MoM (p < 0.001), hydrops (p < 0.001) and early gestational age at first transfusion (p = 0.029) CONCLUSION: Anti-D remains the most common antibody in fetuses requiring intrauterine transfusion. A low or high-risk classification for fetal anemia based on the type of antibody, paternal phenotype and fetal antigen allows follow-up of the pregnancy accordingly, with good perinatal outcomes in the low-risk group. In the high-risk group, adverse perinatal outcomes are related to high MCA-PSV, hydrops and early gestational age at first transfusion. BioMed Central 2019-10-15 /pmc/articles/PMC6794826/ /pubmed/31615430 http://dx.doi.org/10.1186/s12884-019-2525-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Sánchez-Durán, María Ángeles
Higueras, María Teresa
Halajdian-Madrid, Cecilia
Avilés García, Mayte
Bernabeu-García, Andrea
Maiz, Nerea
Nogués, Nuria
Carreras, Elena
Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title_full Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title_fullStr Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title_full_unstemmed Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title_short Management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
title_sort management and outcome of pregnancies in women with red cell isoimmunization: a 15-year observational study from a tertiary care university hospital
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794826/
https://www.ncbi.nlm.nih.gov/pubmed/31615430
http://dx.doi.org/10.1186/s12884-019-2525-y
work_keys_str_mv AT sanchezduranmariaangeles managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT higuerasmariateresa managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT halajdianmadridcecilia managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT avilesgarciamayte managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT bernabeugarciaandrea managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT maiznerea managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT noguesnuria managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital
AT carreraselena managementandoutcomeofpregnanciesinwomenwithredcellisoimmunizationa15yearobservationalstudyfromatertiarycareuniversityhospital