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产前Rh免疫球蛋白 (RhIG) 剂量,时间和在选择的程序和并发症后的指示:范围审查
Laura Tapley1, Lani Lieberman2, Gwen Clarke3
1Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada, Department of Pathology and Laboratory Medicine, Interior Health, Kelowna General Hospital, Kelowna, British Columbia, Canada.
在产前事件后的 RhD 阴性怀孕中, RhD 与免疫接种的风险增加. 证据支持RhIG预防,但低质量的数据需要通过高质量的试验进行重新评估.
科学领域:
- 产科和妇科 产科和妇科
- 免疫学 免疫学 免疫学
- 围产儿医学 围产儿医学
背景情况:
- 有限的研究涉及RhD与产前程序后的免疫接种.
- 对于RhD-免疫球蛋白 (RhIG) 的使用实践有所不同.
- 对 RhD 阴性怀孕的 RhIG 疗效进行评估,对于产前后发生的事件至关重要.
研究的目的:
- 评估 RhD 阴性怀孕中 RhIG 疗效的证据.
- 评估RhD与免疫接种风险在特定的产前手术和并发症后.
主要方法:
- 从1946年到2024年8月,对主要医学数据库 (MEDLINE,EMBASE,CINAHL,Cochrane EBM) 进行了全面的文献搜索.
- 包括专注于 RhIG 在产前手术或并发症后的疗效的研究.
- 分析了31篇关于RhD与免疫接种风险和RhIG管理的论文,这些论文涉及诸如CVS,羊膜切割,ECV,宫外怀孕,创伤,胎盘前期和胎盘断裂等事件.
主要成果:
- 所有分析的产前干预和并发症都被发现增加了RhD与免疫接种的风险.
- 研究评估了免疫接种或胎儿-母亲出血 (FMH) 作为结果.
- 大多数被纳入的研究都是观察性研究,质量和方法可变,主要是在1995年之前进行的.
结论:
- 目前的文献支持 RhIG 预防列出的产前手术和并发症.
- 证据受限于方法质量低下和使用代用标记物的证据.
- 需要高质量的试验来重新评估RhIG预防,考虑到目前的做法和RhIG供应.
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