[Pre- and postnatal treatment of severe Rh-erythroblastosis (author's transl)]

162 children with severe Rh-erythroblastosis were treated with 326 prenatal blood transfusions. 89 (55%) survived. The indication and technique for this treatment and the postnatal intensive care of the newborn are reported. Prenatal diagnosis is extended by the author's immunofluorescence technique assessing the fetal Rh factor D even as minute contamination amongst other cells, in order to privente unnecessary treatment of Rh negative children. Checking the effectiveness of prenatal blood-transfusion this technique can demonstrate differences in the counts of HbF- and D-cells. Success of treatment appears to be, in part, determined by dexamethasone just before delivery and by immediate postnatal substitution of erythrocyte concentrates and following exchange transfusion. With increasing experience the percentage of successful treatment rose. Of 40 children treated during the last 2 years with 95 prenatal transfusions, 67,5% survived. 41 fetuses had ascites already at the first prenatal transfusion. 9 of them (22%) survived. The data of the children treated, earliest in the 21st week of pregnancy, are given: Bilirubin level in amniotic fluid, number of prenatal transfusions, gestational week at delivery, hematocrit, HbF cells, number of postnatal exchange transfusions and later transfusions. Postnatal development of successfully treated children corresponds to that of other premature children without erythroblastosis.