title: The importance of antenatal prevention of RhD immunisation in the first pregnancy.
abstract: BACKGROUND
  The aim of this study was to examine which pregnancies are associated with RhD immunisation and haemolytic disease of foetus and newborn (HDFN) when postnatal RhD prophylaxis is applied.
  
  
  METHODS
  This retrospective cohort study included pregnancies with RhD immunisation; each of the pregnant women received anti-D immunoglobulin after delivery, miscarriage or invasive antenatal diagnostic procedures. For each pregnancy we analysed the order of pregnancy that caused immunisation as well as the order of the monitored pregnancy and whether the anti-D antibodies caused HDFN.
  
  
  RESULTS
  Anti-D antibody was detected in 1.2% of RhD-negative pregnancies. Out of 89 monitored pregnancies, 56 (63%) were immunised by the first pregnancy, 21 (24%) by the second one, and 12 (13%) by subsequent pregnancies. HDFN occurred in 28 cases; 25 of them were the consequence of the immunisation in the first pregnancy. The most severe cases of HDFN, perinatal death (n=2) and intrauterine transfusion (n=7) were consequence of immunisation during the first pregnancy. Significantly more cases of HDFN were caused by immunisation in the first pregnancy than by immunisation in subsequent pregnancies (χ(2)=12, p<0.01).
  
  
  CONCLUSIONS
  RhD immunisation could be reduced in more than half cases by administering anti-D immunoglobulin at the beginning of the third trimester of pregnancy, especially the first pregnancy.
authors.affiliation: Department of Transfusion Medicine, Split University Hospital Centre, Split, Croatia.
authors.forename: Slavica
authors.initials: S
authors.lastname: Dajak
authors.affiliation: Department of Obstetrics and Gynaecology, Split University Hospital Centre, Split, Croatia.
authors.forename: Damir
authors.initials: D
authors.lastname: Roje
authors.affiliation: Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
authors.forename: Željka Hundrić
authors.initials: ŽH
authors.lastname: Hašpl
authors.affiliation: Department of Transfusion Medicine, Split University Hospital Centre, Split, Croatia.
authors.forename: Pera Erceg
authors.initials: PE
authors.lastname: Maglić
mesh_terms: D000328:Adult; D004899:Erythroblastosis, Fetal / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D005331:Fetomaternal Transfusion / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*
chemical_list: D007155:Immunologic Factors; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin; C026410:Rho(D) antigen