Gestation outcomes in various options of help for pregnant women with Rh-immunization

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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.

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 Petersburg

Dmitry 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 Petersburg

Vitaly 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 Petersburg

Larisa 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 Petersburg

Lyudmila 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 Petersburg

Alexey 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 Petersburg

Gulnaz 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 Petersburg

Svetlana 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 Petersburg

Philip 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 Petersburg

Mikhail A. Vyugov

Maternity Hospital

Email: mikhailvyugov@yandex.ru

MD, PhD, Anesthesiologist-Intensivist

Russian Federation, Taganrog

Valeria 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-Don

Natalia 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; Khabarovsk

Svetlana 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, Donetsk

Anna 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, Donetsk

Alexander 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 Petersburg

Vladislav A. Вarinov

Psychoneurological Dispensary of the Rostov Region

Email: vetrovplasma@mail.ru

PhD, MD, Neonatologist, Anesthesiology and Resuscitation Group

Russian Federation, Rostov-on-Don

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