Report of the first nationally implemented clinical routine screening for fetal RHD in D- pregnant women to ascertain the requirement for antenatal RhD prophylaxis
Report of the first nationally implemented clinical routine screening for fetal RHD in D- pregnant women to ascertain the requirement for antenatal RhD prophylaxis
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DOI：
10.1111/j.1537-2995.2011.03362.x
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发表时间：
2012-04-01
期刊：
影响因子：
2.9
通讯作者：
Dziegiel, Morten Hanefeld
中科院分区：
文献类型：
--
作者：
Clausen, Frederik Banchpdf;Christiansen, Mette;Dziegiel, Morten Hanefeld
背景技术背景：产前和产后RhD预防相结合是更有效地减少D免疫在怀孕比产后RhD预防单独。根据胎儿RHD基因的产前筛查结果，丹麦的产前RhD预防仅适用于携带D+胎儿的D-妇女。我们提出了一个评估的第一个国家的产前RHD screening.Study设计和方法的临床应用：在每个丹麦的五个医疗保健地区，血液样本从D-妇女在GEORGE第25周。从母体血浆中提取DNA，并通过实时聚合酶链反应靶向两个RHD外显子分析RHD基因的存在。对2312例孕妇的新生儿血清学分型与胎儿RhD分型的预测进行了比较，新生儿血清学分型代表了前6个月的常规分析结果：胎儿RhD检测的敏感性为99.9%。准确率为96.5%。在862例（37.3%）中，正确避免了对携带D-胎儿的妇女进行不必要的产前RhD预防的建议，而39例（1.7%）被建议进行不必要的产前RhD预防。两个RHD+胎儿（0.087%）未被检测到，产前RhIG是不given.CONCLUSION：这些数据代表了第一次演示的可靠性，常规产前胎儿RHD筛查D-，孕妇，以确定产前RhD预防的要求。我们的研究结果应该鼓励在全球范围内实施这种筛查计划，以减少不必要的RhIG使用。
BACKGROUND: A combination of antenatal and postnatal RhD prophylaxis is more effective in reducing D immunization in pregnancy than postnatal RhD prophylaxis alone. Based on the result from antenatal screening for the fetal RHD gene, antenatal RhD prophylaxis in Denmark is given only to those D- women who carry a D+ fetus. We present an evaluation of the first national clinical application of antenatal RHD screening.STUDY DESIGN AND METHODS: In each of the five Danish health care regions, blood samples were drawn from D-women in Gestational Week 25. DNA was extracted from the maternal plasma and analyzed for the presence of the RHD gene by real-time polymerase chain reaction targeting two RHD exons. Prediction of the fetal RhD type was compared with serologic typing of the newborn in 2312 pregnancies, which represented the first 6 months of routine analysis.RESULTS: For the detection of fetal RHD, the sensitivity was 99.9%. The accuracy was 96.5%. The recommendation for unnecessary antenatal RhD prophylaxis for women carrying a D-fetus was correctly avoided in 862 cases (37.3%), while 39 women (1.7%) were recommended for antenatal RhD prophylaxis unnecessarily. Two RHD+ fetuses (0.087%) were not detected, and antenatal RhIG was not given.CONCLUSION: These data represent the first demonstration of the reliability of routine antenatal fetal RHD screening in D-, pregnant women to ascertain the requirement for antenatal RhD prophylaxis. Our findings should encourage the implementation of such screening programs worldwide, to reduce the unnecessary use of RhIG.