Management of platelet and RhD maternal immunizations by PCR phenotypings after early amniocentesis

This study evaluates the possibilities of prenatal diagnosis of maternofetal platelet and anti-RhD incompatibilities by using molecular typing on amniocytes. Twenty-four amniocenteses were performed between 15 and 35 weeks of gestation (WG), 19 times for study of the fetal karyotype and 5 times because of anti-D immunization. HPA-1, HPA-3 and HPA-5 platelet phenotypes using PCR-RFLP and RhD phenotypes using amplification-refractory mutation system PCR were assessed in amniotic fluid and compared with those of fetal (15 times) or newborn (9 times) blood and with parental phenotypes (46 blood samples). The four phenotypes were always determined in amniocytes, and no discrepancies with fetal blood or parental phenotypes were noted. The reliability and low iatrogenicity of this method makes it suitable for amniocentesis from 15 WG onward in any woman whose spouse is likely to be heterozygous. These allow radical change with a clear beneficial effect in obstetrical care of immunized women.