Rh阴性孕妇的产前免疫血液学检查及妊娠结局分析

发布时间：2018-08-07 20:32

【摘要】：目的:探讨Rh阴性孕妇产前免疫血液学检查和结局分析。方法:回顾性分析2010年1月至2016年12月期间在我院孕检及分娩的22880例孕妇中有Rh阴性孕妇287例(1.25%),用血清学方法确认血型D抗原阴性、Rh系统其他抗原表现型及抗体筛选;对有抗-D抗体孕妇进一步做抗体效价及分娩后根据新生儿黄疸指数做新生儿溶血病检测。部分Rh阴性孕妇于孕37周做预存式自体备血。结果:Rh阴性孕妇287例中,有12例(4.18%)检出抗-D抗体,抗原表现型均为ccee,且均有完整生育史。90例有1胎生育史中检出抗-D抗体10例(11.11%),15例有2胎生育史中检出抗-D抗体2例(13.33%)。287例孕妇生育290个新生儿中有8个发生胎儿新生儿Rh溶血病,发生率占2.75%(8/290)。12例抗-D抗体孕妇中1例宫内有溶血,出生后治疗无效死亡,7例出生后发现新生儿黄疸,经换血等治疗后治愈,其余4例新生儿无黄疸出现。146例Rh阴性孕妇孕37周实施了预存式自体备血,剖宫产与经阴道分娩产妇比较自体备血与未自体备血者产后出血量,显示两组差异均无统计学意义(P0.05)。结论:有完整生育史且抗原表现型为"ccee"Rh阴性孕妇发生抗-D同种免疫反应可能会加大,但新生儿结局差异很大;Rh阴性孕妇分娩前可根据自身状况做预存式自体备血。
[Abstract]:Objective: to investigate the prenatal immunological examination and outcome analysis of Rh negative pregnant women. Methods: from January 2010 to December 2016, 287 cases (1.25%) of 22880 pregnant women with Rh negative in pregnancy and delivery in our hospital were analyzed retrospectively. Other antigen phenotypes and antibody screening of Rh system were confirmed by serological method. The antibody titers of pregnant women with anti-D antibody and neonatal hemolytic disease were determined according to neonatal jaundice index after delivery. Some Rh-negative pregnant women received pre-stored autologous blood at 37 weeks of gestation. Results Anti-D antibody was detected in 12 of 287 cases (4.18%) of 287 pregnant women with negative Rh. The antigenic phenotypes were ccee.There were 10 cases (11.11%) of anti-D antibody detected in 10 cases (11.11%) and 2 cases (13.33%) of 2 cases of anti-D antibody in all the 90 cases with complete fertility history and 8 cases of Rh hemolytic disease in 8 out of 290 newborns of 287 pregnant women, among which 10 cases (11.11%) had anti-D antibody in 15 cases (11.11%) and 2 cases (13.33%) had anti-D antibody in 2 cases (13.33%) of 287 newborns. The incidence rate was 2.75% (8 / 290). One of 12 pregnant women with anti-D antibody had intrauterine hemolysis. The remaining 4 newborns without jaundice. 146 cases of Rh negative pregnant women performed preexisting autologous blood reserve at 37 weeks of pregnancy. The volume of postpartum hemorrhage in cesarean section and vaginal delivery was higher than that in vaginal delivery. There was no significant difference between the two groups (P0.05). Conclusion: the anti-D alloimmune reaction may increase in pregnant women with a complete reproductive history and antigen phenotype "ccee" Rh negative, but the neonatal outcome of Rh negative pregnant women may be pre-stored autologous blood reserve according to their own condition before delivery.
【作者单位】：上海交通大学附属上海市第六人民医院;
【分类号】：R714

【相似文献】