Gebelikte Rh Alloimmünizasyonu
Özet
Maternal alloimmünizasyon, gebenin bağışıklık sisteminin yabancı eritrosit yüzey antijenleri tarafından uyarılması ve IgG antikorları üretmesiyle oluşur; en sık nedenleri kan transfüzyonu ve fetal-maternal kanamadır. Rh alloimmünizasyonu yaklaşık 1-2/1000 kadında görülen, fetal aneminin önde gelen sebeplerinden biri olan nadir bir gebelik patolojisidir. İlerleyen gebelik yaşı ve doğumun yanı sıra düşük, ektopik gebelik ile amniyosentez gibi invaziv işlemler fetal-maternal kanamaya yol açarak duyarlılık oluşturabilir. Önleme amacıyla, tüm RhD-negatif gebelere ilk muayenede antikor taraması yapılmalı, taraması negatif olanlara ise gebeliğin 28. haftasında ve doğum sonrasındaki ilk 72 saatte anti-D immünglobulin profilaksisi uygulanmalıdır. Klinik olarak anlamlı antikor saptanan gebelerde takip seri antikor titreleriyle gerçekleştirilir. Kritik titre eşiği (genellikle 1:16-32) aşıldığında, fetusun orta serebral arter-tepe sistolik hızı (MCA-PSV) Doppler ölçümleriyle anemi yönünden izlenir. MCA-PSV değerinin 1,5 MoM üzerinde olması ciddi anemiye işaret eder ve kordosentez ile intrauterin fetal kan transfüzyonunu veya gebelik haftasına göre doğum planlamasını gerektirir. Rh alloimmünizasyonu, intrauterin fetal ölüm ve ciddi yenidoğan hemolitik hastalığı riski nedeniyle önemli bir halk sağlığı problemidir.
Maternal alloimmunization occurs when the pregnant woman's immune system is stimulated by foreign erythrocyte surface antigens, resulting in the production of IgG antibodies, with the most common causes being blood transfusion and fetal-maternal hemorrhage. Rh alloimmunization is a rare pregnancy pathology seen in approximately 1-2/1000 women and stands as a leading cause of fetal anemia. Progressing gestational age and delivery, as well as miscarriage, ectopic pregnancy, and invasive procedures like amniocentesis, can induce fetal-maternal hemorrhage and lead to sensitization. For prevention, all RhD-negative pregnant women must undergo antibody screening during their first visit; those with negative screening should receive anti-D immunoglobulin prophylaxis at the 28th week of gestation and within the first 72 hours following delivery. In pregnancies where clinically significant antibodies are detected, follow-up is conducted via serial antibody titers. If the critical titer threshold (typically 1:16-32) is exceeded, the fetus is monitored for anemia using middle cerebral artery peak systolic velocity (MCA-PSV) Doppler measurements. An MCA-PSV value above 1.5 MoM indicates severe anemia, necessitating cordocentesis and intrauterine fetal blood transfusion, or delivery planning depending on the gestational week. Rh alloimmunization remains a significant public health problem due to the risks of intrauterine fetal death and severe neonatal hemolytic disease.
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