Reduction of Rh0(D) sensitization: a cost-effective analysis.

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Public Health

Background:

• Rh0(D) sensitization poses a significant risk during pregnancy.
• Previous studies on gestational sensitization incidence in the US were limited.
• Understanding sensitization rates is crucial for effective prevention strategies.

Purpose of the Study:

• To determine the incidence of gestational Rh0(D) sensitization in a large US population.
• To analyze the cost-effectiveness of different Rh0(D) prevention strategies.
• To evaluate the efficacy of Rh0(D) immune globulin (RhoGAM) administration.

Main Methods:

• Retrospective analysis of 3995 Rh0(D)-negative pregnancies from 40,319 deliveries (1976-1978).
• Identification of gestational sensitization cases and RhoGAM failures.
• Cost-effectiveness analysis of prophylactic RhoGAM at 28 weeks gestation versus postpartum administration and Fetaldex testing.

Main Results:

• The incidence of gestational Rh0(D) sensitization was 1.0% (21 out of 2098 pregnancies).
• Of 61 sensitized pregnancies, 38 had prior sensitization, 21 were gestational, and 2 were RhoGAM failures.
• Prophylactic RhoGAM at 28 weeks gestation was identified as the most cost-effective prevention method.

Conclusions:

• Gestational Rh0(D) sensitization occurs at a notable rate, necessitating effective prevention.
• Administering prophylactic Rh0(D) immune globulin (RhoGAM) at 28 weeks gestation is the most cost-effective strategy.
• Universal RhoGAM administration to Rh0(D)-negative mothers with Rh0(D)-positive fetuses is essential.