Course and perinatal outcomes of multiple pregnancy with Rh-alloimmunization
AbstractThe frequency of Rh-alloimmunization in multiple pregnancy has decreased to 0.1% in recent decades due to the introduction of immunoprophylaxis. Nevertheless the problem of managing and improving outcomes of multiple pregnancies in patients with Rh-alloimmunization remains relevant, and therefore we analyzed the literature data regarding this problem.
Determination of the middle cerebral artery peak systolic velocity (MCA-PSV) is currently the main non-invasive diagnostic method of fetal anemia caused by hemolytic disease (HDF). However, the question regarding using a 1.5 multiples of the median (MoM) threshold for the prediction of fetal anemia and determination of indications for intrauterine transfusions (IUTs) in multiple pregnancies remains controversial.
IUT is the most effective method of severe forms of hemolytic fetal disease treatment in both singleton and multiple pregnancies. Discordant intrauterine treatment is performed in some cases of multiple pregnancies and severe forms of HDF – different fetuses receive different amounts of IUTs.
According to a low likelyhood of Rh-alloimmunization in multiple pregnancy, diagnostic predictors of the best timing for the IUTs, the onset and frequency of IUTs, duration of intrauterine treatment, risk factors of adverse perinatal outcomes, optimal timing and mode of delivery, features of management of pregnant women with HDF which depend on the chorionicity, have not been determined. It confirms the expediency of researches in this issue.
Keywords:Rh-alloimmunization; hemolytic disease; fetal Doppler; middle cerebral artery; multiple pregnancy
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
Contribution. Сoncept and design – Konoplyannikov A.G.; data collection and processing – Kiryuschenkov A.P.; text writing – Kiryuschenkov A.P., Kalashnikov S.A.; editing – Konoplyannikov A.G., Sichinava L.G.
For citation: Kiryuschenkov A.P., Konoplyannikov A.G., Sichinava L.G., Kalashnikov S.A. Course and perinatal outcomes of multiple pregnancy with Rh-alloimmunization. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training]. 2023; 11 (4): 45–52. DOI: https://doi.org/10.33029/2303-9698-2023-11-4-45-52 (in Russian)
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