Pregnancy immunizations

The Department of Obstetrics and Gynecology at Örebro University Hospital has long had a special perinatal team including obstetricians, blood group serologists, and neonatologists, who discuss and recommend testing, work-up, and treatment for acquired alloimmunization during pregnancy.  The perinatal team is available for consultation in pregnancy immunizations throughout Sweden.

In recent years our policy has been to control, monitor and, where appropriate, to treat the pregnant woman and fetus without using invasive procedures such as amniocentesis, umbilical cord sampling (cordocentesis), or intrauterine transfusions, a test and treatment that significantly increases the risk of a worsening situation regarding acquired immunization.

Initially, we recommend repeated determinations of titer levels; in Rh immunization, testing is often complemented with determination of anti-D concentrations.  In case of suspected fetal distress of a more serious nature, we supplement with ultrasound to see any signs of anemia in the fetus, and measurement of blood flow in the CNS vessels (arteria cerebri media).  We also have the option, where needed, to order work-up of fetal blood group when we suspect immunization against blood groups RhD, Rhc Kell, or Duffy (Fy).  This can be carried out on a blood sample from the mother.

First-hand treatments that may be required in cases of serious immunization are plasma exchange treatment of the mother and/or high-dose treatment with immunoglobulin (IVIG).

In severe immunization where we have assessed that there is a risk that the newborn will need blood exchange, we will take a decision as to suitable delivery unit, in cooperation with the Neonatal Intensive Care Unit.

The perinatal team meets once a week to discuss current cases and to make recommendations for further management of pregnancy immunization.

Page revised Thursday, April 7, 2011

Content manager: Margareta Fredriksson

Published by Anita Pettersson