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Intranasal Immunization and Milk Collection in Studies of Maternal Immunization in New Zealand White Rabbits (Oryctolagus cuniculus)

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Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis.

J M Koelewijn¹, M de Haas, T G M Vrijkotte

¹Sanquin Research, Amsterdam, and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

BJOG : an International Journal of Obstetrics and Gynaecology

|June 23, 2009

Summary

Risk factors for Rhesus D (RhD) immunisation include non-spontaneous delivery and postmaturity, even with anti-D immunoglobulin prophylaxis. Extra anti-D Ig may improve prevention in high-risk pregnancies.

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Intranasal Immunization and Milk Collection in Studies of Maternal Immunization in New Zealand White Rabbits (Oryctolagus cuniculus)

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Published on: January 2, 2013

Area of Science:

Obstetrics and Gynecology
Immunology
Perinatal Medicine

Background:

Rhesus D (RhD) immunisation poses risks during pregnancy.
Standard anti-D immunoglobulin (Ig) prophylaxis aims to prevent RhD immunisation.
Failures in prophylaxis necessitate identifying associated risk factors.

Purpose of the Study:

To identify risk factors for RhD immunisation in pregnancies with prior adequate anti-D Ig prophylaxis.
To gather evidence for enhancing primary prevention strategies through targeted anti-D Ig administration.

Main Methods:

A nationwide case-control study evaluated the Dutch antenatal anti-D-prophylaxis programme.
Cases comprised 42 RhD-immunised women (parae-1) receiving prophylaxis in their first pregnancy.
Controls included 339 women (parae-1) without red cell antibodies.

Main Results:

Independent risk factors for RhD immunisation were non-spontaneous delivery (OR 2.23), postmaturity (OR 3.07), and pregnancy-related red blood cell transfusion (OR 3.51).
Advanced maternal age was also a risk factor (OR 0.89/year).
In 43% of cases, no identified categorical risk factors were present.

Conclusions:

At least half of prophylaxis failures were linked to increased fetomaternal haemorrhage (FMH) or insufficient anti-D Ig levels.
Improved prevention may involve strict adherence to FMH determination guidelines and adjusted anti-D Ig prophylaxis.
Routine extra anti-D Ig administration after non-spontaneous delivery or complicated/prolonged labor is suggested.