CAUSES AND CLINICAL CONSEQUENCES OF RHESUS (D) HEMOLYTIC-DISEASE OF THE NEWBORN - A STUDY OF A SCOTTISH POPULATION, 1985-1990

Objective To identify the reasons behind failures to prevent the devel opment of Rhesus (D) haemolytic disease of the newborn. Design Retrosp ective analysis of the case records of all pregnancies that resulted i n the birth of an infant with a positive direct antiglobulin test on t he cord red cells born to Rh(D) negative women between 1 April 1985 an d 31 March 1990. Setting Obstetric units in the South East Scotland re gion and the South East Scotland Regional Blood Transfusion Service An tenatal Laboratory. Main outcome measures The causes and clinical cons equences of maternal immunisation to the Rhesus (D) antigen. Results B etween 1985 and 1990, 80 pregnancies resulted in the birth of an infan t sensitised with anti-D on the cord red cells. There were no deaths d ue to haemolytic disease, but considerable resources were deployed in obstetric and neonatal care for these pregnancies. Sufficient data wer e available to categorise the cause of maternal immunisation in 70 pre gnancies. Seven cases were due to immunisation by pregnancy before 197 0. Sixty-three cases could be attributed to failure of the Rhesus prog ramme: 10 cases (16%) were due to failure to implement the programme a dequately, the other 53 cases (84%) were due to failure of the current guidelines to provide adequate protection. Late immunisation in an un complicated pregnancy was the single commonest identifiable cause. Con clusions It is likely that substantial further reductions in Rhesus (D ) immunisation and haemolytic disease of the newborn will require chan ges in the Rhesus prevention programme. In particular the role of ante natal prophylaxis requires detailed consideration.