Changing trends in the management of red blood cell alloimmunization in pregnancy.

PROBLEM: Review the current management of red blood cell alloimmunization in pregnancy.

METHODS: Retrospective review of the literature and 8-year experience at Baylor College of Medicine, Houston, Tex.

RESULTS: Rhesus alloimmunization continues to affect one in 1000 pregnancies. Newly diagnosed disease can be managed with serial anti-human globulin titers until a critical value is achieved. Thereafter diagnostic modalities include ultrasound, amniocentesis, and percutaneous umbilical blood sampling. Patients with a history of a previously affected pregnancy should be managed in a more aggressive fashion. Newer methods of intravascular intrauterine transfusion can result in neonatal survival in more than 75% of cases. Long-term evaluation of these neonates indicates a good neurologic outcome.

CONCLUSIONS: New approaches to therapy using preimplantation diagnosis or selective suppression of the maternal immune system appear promising for the future.