Perinatal mortality from Rh(D) hemolytic disease in Finland, 1975-1984

Analysis of 41 deaths from Rh(D) hemolytic disease (HDN) in Finland in the past 10 years revealed that 17 occurred in mothers immunized before anti-D IgG was available and three in mothers immunized by blood transfusion in earlier years. Nine deaths were related to loopholes in the anti-D program and could presumably have been prevented by ensuring that all eligible Rh-negative women received anti-D IgG after delivery and abortion. Six deaths were due to immunization during a first pregnancy after the 28th week and three to maternal immunization despite anti-D IgG. Immunization from these sources can only be reduced by anti-D IgG injected antenatally as well as postnatally, though the complete eradication of HDN seems to be beyond our grasp. Giving anti-D IgG to Rh-negative women after the birth of a Rh-positive infant or after an abortion has been common practice in Finland, the former since 1969 and the latter since 1971. Although anti-D prophylaxis has been very effective in reducing the incidence of Rh(D) hemolytic disease, new cases continue to occur. Since the prophylaxis fails to prevent perinatal mortality, we decided to discover how the mothers whose infants died from HDN had become immunized in the past 10 years.