[Anti-D prophylaxis in fetal-maternal erythrocyte incompatibility in Tunisia]

Generalization of postnatal prophylaxis using anti-D immunoglobulins decreased the incidence of erythrocyte fetal-maternal incompatibility (EFMI) in the Rhesus system. Few recent studies have investigated the situation of anti-D prophylaxis in Tunisia and its effects on maternal and neonatal health. The aim of this study was therefore to analyze the situation of anti-D prophylaxis in Tunisia to detect defects and propose solutions. We conducted a retrospective descriptive study of IFME cases in the rhesus system in the Department of Medicine and Neonatal Resuscitation of the Tunis Maternity and Neonatology Center (CMNT) during an 8-year period from 1 January 2006 to 31 December 2015. We collected 51 cases of IFME. The prevalence of IFME was 3.4 per 10 000 live births; 41 % of the patients were transferred in utero and they were from the northwest of the country (17 %). The rate of women with a history of at least one spontaneous miscarriage (SCF) was 45 %. In 42 % of the cases, pregnancies were monitored at local clinics. The search for irregular agglutinins (RAI) was performed in 86 % of the women studied. RAI was positive in 97 % of the cases. Anti-D prophylaxis was correctly performed in only 27 % of the cases. The systematic prophylaxis of the third trimester and a systematic Kleihauer test must be combined with postpartum prophylaxis to better identify dysfunctions and improve the application of the recommendations.