International Journal of Infertility & Fetal Medicine

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VOLUME 13 , ISSUE 3 ( September-December, 2022 ) > List of Articles


Management of Rh-negative Alloimmunized Pregnancy Optimizing Perinatal Mortality and Morbidity: A Single-center Study

Devendra Arora, Madhusudan Dey, Sanjay Singh, Abhijeet Kumar, Vinod G Nair

Keywords : Exchange transfusion, Fetal anemia, Indirect Coombs test, Intrauterine transfusion, Perinatal mortality, Rhesus isoimmunization

Citation Information : Arora D, Dey M, Singh S, Kumar A, Nair VG. Management of Rh-negative Alloimmunized Pregnancy Optimizing Perinatal Mortality and Morbidity: A Single-center Study. Int J Infertil Fetal Med 2022; 13 (3):111-115.

DOI: 10.5005/jp-journals-10016-1291

License: CC BY-NC 4.0

Published Online: 29-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Objective: The aim of the study was to report pregnancy and fetal outcomes of Rhesus (Rh)-negative pregnancy at a tertiary care teaching hospital. Materials and methods: Prospective observational study was carried out on all Rh-negative women over 3 years period. On the basis of the evolution of indirect Coombs test (ICT), titer and middle cerebral artery peak systolic velocity (MCA-PSV) value, women were categorized into five groups. In the group with ICT >1:32 and MCA-PSV >1.5, multiple of median (MOM) or any features of hydrops underwent intrauterine transfusion (IUT). Pregnancy outcomes, neonatal outcomes, and procedure-related adverse events were analyzed. Results: A total of 496 women were recruited, out of which 411 were non-alloimmunized, and 85 were alloimmunized. Out of 85 alloimmunized pregnancies, 47 fetuses underwent 148 IUT. The overall perinatal mortality was 1/47, while adverse procedure-related complication was nil in fetuses who underwent IUT. In the IUT group without hydropic fetuses, there was no mortality, but 100% of newborns underwent phototherapy, and 30% underwent exchange transfusion, which was better than the previous studies. In the IUT group with hydropic fetuses, one fetus had mortality out of seven has a cumulative perinatal loss rate of 14%. The procedure-related complication rate was 4.7%. Conclusion: In the absence of fetal hydrops, IUT has a good prognosis with 100% fetus survival in our center. Advancement in neonatal management [concomitant use of phototherapy and intravenous immunoglobulin (IVIG)] of IUT-received fetuses has significantly reduced morbidity related to hemolytic disease of the fetus and newborn (HDFN). Early detection of pregnancy at risk of fetal anemia using ICT titer and MCA-PSV trend and timely management of fetus at risk of anemia using IUT at fetal medicine center leads to a favorable outcome.

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