Gestation outcomes in various options of help for pregnant women with Rh-immunization
- Authors: Vetrov V.V.1, Ivanov D.O.1, Reznik V.A.1, Romanova L.A.1, Kurdynko L.V.1, Nikolaev A.V.1, Sadykova G.K.1, Menshikova S.V.1, Ovsyannikov P.A.2, Vyugov M.A.3, Avrutskaya V.V.4, Vladimirova N.Y.5,6, Chermnykh S.V.7, Zheleznaya A.A.7, Koroteev A.L.8, Вarinov V.A.9
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Affiliations:
- Saint Petersburg State Pediatric Medical University
- Perinatal Center, Almazov National Medical Research Centre
- Maternity Hospital
- Rostov State Medical University
- G.S. Postol Perinatal Center
- Institute for Advanced Training of Healthcare Professionals
- Donetsk Republican Center of Maternal and Child Health, M. Gorky Donetsk National Medical University
- Diagnostic Center (Medical Genetic)
- Psychoneurological Dispensary of the Rostov Region
- Issue: Vol 14, No 2 (2023)
- Pages: 5-16
- Section: Editorial
- URL: https://journals.rcsi.science/pediatr/article/view/131606
- DOI: https://doi.org/10.17816/PED1425-16
- ID: 131606
Cite item
Abstract
BACKGROUND: To date, several options for helping pregnant women with rhesus immunization are known: (a) “active tactics” in carrying out methods of efferent therapy in the form of basic operations (plasmapheresis, hemosorption) in combination with adjuvant methods (immunoglobulin, blood photomodification with ultraviolet, laser beams, ozone therapy) to pregnant women; (b) “wait-and-see active tactics” with observation of the pregnant woman, followed by intrauterine intravascular transfusions of washed donor red blood cells; (c) “mixed active tactics” with a sequential combination, alternation of these methods. In Russia, only option 2 with fetal transfusions of washed donor red blood cells is accepted as the basis and paid for. The objective of the study is to conduct a comparative analysis of pregnancy outcomes in women with rhesus immunization using different management options.
MATERIALS AND METHODS: A total of 392 women were followed up at seven different institutions in Russia and at the Donetsk Center for Maternal and Child Health (DNR), of whom 345 pregnant women (Group 1) received efferent therapy, 33 women (Group 2) had fetuses intrauterine bypass surgery, and 14 pregnant women (Group 3) had mixed efferent therapy and fetal PEEP bypass surgery.
RESULTS: The analysis showed that the most favorable results for the main clinical indicators (premature, operative delivery, fetal hypoxia at birth, etc.) were in Group 1 and 3 women, in which the perinatal mortality was 14.5/1000 and 0/1000, respectively, which was significantly lower than in Group 2 (176.5/1000). It was also found that in Groups 2 and 3 women, the mean intervals between repeated transfusions of washed donor red blood cells were 8.8 ± 0.2 and 21.4 ± 3.8 days (p < 0.01), which may be explained by the detoxifying effect of efferent therapy methods, preservation of fetal red blood cells and transfused donor red blood cells to the fetus with prolonged gestation and obtaining healthier and more viable progeny.
CONCLUSIONS: 1. Severe Rh conflict is a manifestation of a syndrome of systemic effects of aggressive metabolites of specific and nonspecific nature. 2. The etiopathogenetic measure in the prevention and treatment of HDF/HDN in rhesus conflict is efferent therapy methods for the mother, and transfusion of washed donor rhesus-negative red blood cells to the fetus is effective, but a temporary, palliative measure, as is the case in multiple organ failure. 3. In the treatment protocols, efferent therapy methods must be present to prevent fetal red cell destruction and, equally importantly, to prevent destruction of Rh-negative donor red cells transfused to the fetus.
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##article.viewOnOriginalSite##About the authors
Vladimir V. Vetrov
Saint Petersburg State Pediatric Medical University
Author for correspondence.
Email: vetrovplasma@mail.ru
SPIN-code: 6187-7118
Dr. Sci. (Med.), Associate Professor, Department of Neonatology with courses of Neurology and Obstetrics and Gynecology
Russian Federation, Saint PetersburgDmitry O. Ivanov
Saint Petersburg State Pediatric Medical University
Email: doivanov@yandex.ru
SPIN-code: 4437-9626
MD, PhD, Dr. Sci. (Med.), Professor, Rector, Chief Freelance Neonatologist of the Ministry of Health of Russia
Russian Federation, Saint PetersburgVitaly A. Reznik
Saint Petersburg State Pediatric Medical University
Email: klinika.spb@gmail.com
ORCID iD: 0000-0002-2776-6239
SPIN-code: 9761-6624
MD, PhD, Chief Physician of the Children's Clinical Hospital
Russian Federation, Saint PetersburgLarisa A. Romanova
Saint Petersburg State Pediatric Medical University
Email: l_romanova2011@mail.ru
SPIN-code: 6460-5491
MD, PhD, Department of Obstetrics and Gynecology
Russian Federation, Saint PetersburgLyudmila V. Kurdynko
Saint Petersburg State Pediatric Medical University
Email: l.kurdynko@yandex.ru
SPIN-code: 6879-2546
Head of the Obstetrical Physiology Department
Russian Federation, Saint PetersburgAlexey V. Nikolaev
Saint Petersburg State Pediatric Medical University
Email: vetrovplasma@mail.ru
Assistant of the Department of Modern Diagnostic Methods and Radiation Therapy of prof. S.A. Reinberg
Russian Federation, Saint PetersburgGulnaz K. Sadykova
Saint Petersburg State Pediatric Medical University
Email: kokonya1980@mail.ru
Postgraduate Student, Department of Modern Methods of Diagnosis and Radiotherapy
Russian Federation, Saint PetersburgSvetlana V. Menshikova
Saint Petersburg State Pediatric Medical University
Email: vetrovplasma@mail.ru
Assistant, Department of Modern Diagnostic Methods and Radiation Therapy after prof. S.A. Reinberg
Russian Federation, Saint PetersburgPhilip A. Ovsyannikov
Perinatal Center, Almazov National Medical Research Centre
Email: vetrovplasma@mail.ru
SPIN-code: 2511-2772
MD, PhD, Obstetrician-Gynecologist, Ultrasound Specialist
Russian Federation, Saint PetersburgMikhail A. Vyugov
Maternity Hospital
Email: mikhailvyugov@yandex.ru
MD, PhD, Anesthesiologist-Intensivist
Russian Federation, TaganrogValeria V. Avrutskaya
Rostov State Medical University
Email: vetrovplasma@mail.ru
SPIN-code: 9495-9702
PhD, MD, Dr. Sci. (Med.), Head of the polyclinic
Russian Federation, Rostov-on-DonNatalia Yu. Vladimirova
G.S. Postol Perinatal Center; Institute for Advanced Training of Healthcare Professionals
Email: vetrovplasma@mail.ru
SPIN-code: 2137-9557
PhD, MD, Dr. Sci. (Med.), Professor, Chief Freelance Specialist Obstetrician-Gynecologist of the Ministry of Health of the Khabarovsk Territory; Deputy Chief Physician Professor G.S. Postol Perinatal Center, Ministry of Health of the Khabarovsk Territory; Professor, Department of Obstetrics and Gynecology, Institute for Advanced Training of Healthcare Professionals
Russian Federation, Khabarovsk; KhabarovskSvetlana V. Chermnykh
Donetsk Republican Center of Maternal and Child Health, M. Gorky Donetsk National Medical University
Email: vetrovplasma@mail.ru
SPIN-code: 4566-0589
PhD, MD, Dr. Sci. (Med.), Professor of the Department of Obstetrics, Gynecology, Perinatology, Pediatric and Adolescent Gynecology
Russian Federation, DonetskAnna A. Zheleznaya
Donetsk Republican Center of Maternal and Child Health, M. Gorky Donetsk National Medical University
Email: vetrovplasma@mail.ru
SPIN-code: 7167-7703
PhD, MD, Dr. Sci. (Med.), Professor, Department of Obstetrics, Gynecology, Perinatology, Pediatric and Adolescent Gynecology
Russian Federation, DonetskAlexander L. Koroteev
Diagnostic Center (Medical Genetic)
Email: gkdmgenc@zdrav.spb.ru
SPIN-code: 8702-6057
PhD, MD, Cand. Sci. (Med.), Chief Doctor
Russian Federation, Saint PetersburgVladislav A. Вarinov
Psychoneurological Dispensary of the Rostov Region
Email: vetrovplasma@mail.ru
PhD, MD, Neonatologist, Anesthesiology and Resuscitation Group
Russian Federation, Rostov-on-DonReferences
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