PERFECTION OF THE ALGORITHM FOR MANAGING PREGNANT WOMEN WITH RHESUS IMMUNIZATION: DIAGNOSTIC ASPECTS
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Abstract
Objective – reduction of perinatal morbidity on the basis of the development of a method for predicting hemolytic disease (HD), improving the algorithm for managing patients with Rh-immunization.
Material and methods. The main group I was 42 pregnant with Rh-immunization, the comparison group I is represented by 42 miscarriages with Rh-negative blood accessory. The main group I on the basis of perinatal outcome was divided into 3 subgroups: the first subgroup – newborns with high severity HD (n = 14), the second subgroup – newborns with moderate HD severity (n = 11), the third subgroup of children with mild disease (n = 17). A peak systolic blood flow velocity (PSBFV) was measured in the middle cerebral artery of the fetus (MCA), trophoblastic-β-1-glycoprotein (TBG); on the basis of the data obtained, an integrated approach to the management of pregnant women with Rh-immunization was developed.
Results. It was established that the values of TBG higher than the reference values are associated with the development of hyperbilirubinemia > 57 mmol/l with a sensitivity of 75.0 % (47.6-92.7 %) and a specificity of 91.0 % (81.5-96.6 %), decrease in HB < 153 g/l with a sensitivity of 68 % and a specificity of 86 %. The level of TBG exceeding 400000 ng/ml at the gestational age of 35 weeks or more with a sensitivity of 66.7 % (29.9-92.2 %) and a specificity of 92.2 % (81.1-97.8 %) predicts hyperbilirubinemia newborn and moderate to severe.
The conclusion. The determination of TBG in a rhesus-conflict pregnancy tested at gestational age of 35 or more is an additional criterion for the prediction of an unfavorable perinatal outcome in rhesus immunization. An integrated approach to the management of pregnant women with rhesus immunization can reduce the number of preterm infants with hemolytic disease, the number of children in need of supervision and treatment in the intensive care unitKeywords
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