Rh haemolytic disease: continuing problem of management

Eighteen patients with severe Rh haemolytic disease, all of whom underwent fetal blood sampling and intrauterine transfusion, were studied. Twelve babies survived (67%) all of whom were delivered by lower segment caesarean section. There were three intrauterine deaths resulting in late abortion, one stillbirth with trisomy 21, and two neonatal deaths (both from severe prematurity). The traditional prognostic indicators were all inaccurate, and fetal blood sampling and measurement of the fetal packed cell volume were the most direct methods of assessing haemolysis. The progression of severe Rh disease is unpredictable, and we believe that all cases should be referred to specialist centres for advice or treatment.