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Management of Alloimmunization During Pregnancy

  • Practice Bulletin PB
  • Number 192
  • March 2018

ABSTRACT: When any fetal blood group factor inherited from the father is not possessed by the mother, antepartum or intrapartum fetal–maternal bleeding may stimulate an immune reaction in the mother. Maternal immune reactions also can occur from blood product transfusion. The formation of maternal antibodies, or “alloimmunization,” may lead to various degrees of transplacental passage of these antibodies into the fetal circulation. Depending on the degree of antigenicity and the amount and type of antibodies involved, this transplacental passage may lead to hemolytic disease in the fetus and neonate. Undiagnosed and untreated, alloimmunization can lead to significant perinatal morbidity and mortality. Advances in Doppler ultrasonography have led to the development of noninvasive methods of management of alloimmunization in pregnant women. Together with more established protocols, Doppler ultrasound evaluation may allow for a more thorough and less invasive workup with fewer risks to the mother and fetus. Prevention of alloimmunization is addressed in another Practice Bulletin 1.

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Figures & Tables

Figure 1. Hemoglobin concentrations in 265 healthy fetuses and 111 fetuses that underwent cordocentesis. The reference range in the healthy fetuses was between 0.84 and 1.16 times the median (corresponding to the 5th and 95th percentiles). Values for the 111 fetuses that underwent cordocentesis are plotted individually. Solid circles indicate fetuses with hydrops. (Reprinted from Mari G, Deter RL, Carpenter RL, Rahman F, Zimmeman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultra-sonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity of Anemic Fetuses. N Engl J Med 2000:342:9-14. Copyright 2000 Massachusetts Medical Society. All rights reserved.)

Figure 1. Hemoglobin concentrations in 265 healthy fetuses and 111 fetuses that underwent cordocentesis. The reference range in the healthy fetuses was between 0.84 and 1.16 times the median (corresponding to the 5th and 95th percentiles). Values for the 111 fetuses that underwent cordocentesis are plotted individually. Solid circles indicate fetuses with hydrops. (Reprinted from Mari G, Deter RL, Carpenter RL, Rahman F, Zimmeman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultra-sonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity of Anemic Fetuses. N Engl J Med 2000:342:9-14. Copyright 2000 Massachusetts Medical Society. All rights reserved.)

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Table 1. Atypical Antibodies and Their Relationship to Fetal Hemolytic Disease

Table 1. Atypical Antibodies and Their Relationship to Fetal Hemolytic Disease

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