[Anti-D isoimmunization severe in a twin pregnancy. Case report]

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Immunology

Background:

• Perinatal hemolytic disease (PHD) is a significant cause of fetal and neonatal anemia due to immune-mediated hemolysis.
• RhD alloimmunization is a primary cause of PHD, posing risks to RhD-negative mothers carrying RhD-positive fetuses.
• Managing alloimmunized pregnancies requires careful monitoring and timely intervention to prevent adverse outcomes.

Observation:

• A dichorionic diamniotic twin pregnancy in an RhD-negative woman with poorly controlled diabetes and severe anti-D alloimmunization (titer 1/1024 at 14 weeks) was monitored.
• Previous pregnancies resulted in neonatal deaths and intrauterine fetal deaths, highlighting the high-risk nature of this pregnancy.
• Both twins exhibited severe anemia, detected via middle cerebral artery peak systolic velocity (MCA-PSV) ultrasound from 16 weeks gestation.

Findings:

• The patient received extensive treatment including plasmapheresis, anti-D immunoglobulin, and intrauterine transfusions.
• MCA-PSV monitoring indicated stable but severe anemia in both fetuses throughout the treatment period.
• The pregnancy was successfully terminated via cesarean section at 28 weeks, resulting in live, premature twins in good condition.

Implications:

• Middle cerebral artery peak systolic velocity (MCA-PSV) is a reliable non-invasive tool for predicting moderate-to-severe fetal anemia.
• Accurate prediction of fetal anemia is crucial for clinical management, enabling timely interventions such as intrauterine transfusions or preterm delivery.
• This case underscores the importance of vigilant monitoring and aggressive management in high-risk pregnancies complicated by RhD alloimmunization and twin gestation.