Anti-D administration in pregnancy for preventing Rhesus alloimmunisation

作者：Crowther Caroline A^*; Middleton Philippa; McBain Rosemary D

来源：Cochrane Database of Systematic Reviews, 2013, (2): CD000020.

DOI：10.1002/14651858.CD000020.pub2

• Pregnancy Trimester, Third
• Rh Isoimmunization [prevention %26 control]
• Rho(D) Immune Globulin [therapeutic use]
• Female
• Humans
• Pregnancy

Background %26lt;br%26gt;During pregnancy, a Rhesus negative (Rh-negative) woman may develop antibodies when her fetus is Rhesus positive (Rh-positive). These antibodies may harm Rh-positive babies. %26lt;br%26gt;Objectives %26lt;br%26gt;To assess the effects of antenatal anti-D immunoglobulin on the incidence of Rhesus D alloimmunisation when given to Rh-negative women without anti-D antibodies. %26lt;br%26gt;Search methods %26lt;br%26gt;We searched the Cochrane Pregnancy and Childbirth Group%26apos;s Trials Register (30 September 2012). %26lt;br%26gt;Selection criteria %26lt;br%26gt;Randomised trials in Rh-negative women without anti-D antibodies given anti-D after 28 weeks of pregnancy, compared with no treatment, placebo or a different regimen of anti-D. %26lt;br%26gt;Data collection and analysis %26lt;br%26gt;Two review authors independently assessed trial eligibility and risk of bias and extracted the data. %26lt;br%26gt;Main results %26lt;br%26gt;Two trials with moderate to high risk of bias, involving over 4500 women, compared anti-D prophylaxis with no anti-D during pregnancy. When women received anti-D at 28 and 34 weeks%26apos; gestation, risks of immunisation were not significantly different than for women not given antenatal anti-D: risk ratio (RR) of immunisation during pregnancy was 0.42 (95% confidence interval (CI) 0.15 to 1.17); after the birth of a Rh-positive infant the RR was 0.42 (95% CI 0.15 to 1.17); and within 12 months after birth of a Rh-positive infant the RR was 0.39 (95% CI 0.10 to 1.62). %26lt;br%26gt;However, women receiving anti-D during pregnancy were significantly less likely to register a positive Kleihauer test (which detects fetal cells in maternal blood) in pregnancy (RR 0.60, 95% CI 0.41 to 0.88) and at the birth of a Rh-positive infant (RR 0.60, 95% CI 0.46 to 0.79). No data were available for the risk of Rhesus D alloimmunisation in a subsequent pregnancy. No significant differences were seen for neonatal jaundice, and no adverse effects were reported in either trial. %26lt;br%26gt;Authors%26apos; conclusions %26lt;br%26gt;The risk of Rhesus D alloimmunisation during or immediately after a first pregnancy is about 1%. Administration of 100 mu g (500 IU) anti-D to women in their first pregnancy can reduce this risk to about 0.2% without, to date, any adverse effects. Although unlikely to confer benefit in the current pregnancy, fewer women may have Rhesus D antibodies in any subsequent pregnancy, but the effects of this needs to be tested in studies of robust design.

• 出版日期2013