Obstetric aspects of hemolytic disease of the newborn with ABO-isoimmunization

Background. Currently the problem of immunological conflict, due to incompatibility in the ABO system and the development of hemolytic disease (HD) of the newborn, does not lose its relevance. Unlike Rh isoimmunization, with ABO incompatibility, the development of HD of the fetus/newborn is possible during the first pregnancy and there is no specific prophylaxis.

Aim. To establish prognostically unfavorable obstetric predictors in mothers whose newborns had HD according to the ABO system.

Materials and methods. A retrospective cross-sectional study included 40 newborn-mother pairs. The main group consisted of 17 newborns with a confirmed diagnosis of HD according to the ABO system and their mother, the control group included 23 newborns without HD of the fetus according to the ABO system and their mothers. The medical documentation was studied, which made it possible to evaluate the anamnestic, clinical data and contained a full range of general clinical, laboratory, functional research methods.

Results. When assessing the state of the newborns of the main group, it was revealed that mild HD was detected in 58.8±4.2% of cases (icteric form), in 41.2±5.2% – moderate severity (anemic form – 11.8%, icteric form – 29.4%). Reproductive losses in women of the main group were revealed 1.8 times more often than in the control group (38.6 and 20.9%, respectively; p=0.003). In the main group, 75.5% of patients had one or another acute infectious process during pregnancy. Mothers who gave birth to children with hypertension had high titers of antibodies (anti-A) in the blood and there was no correlation with the severity of HD of the newborn.

Conclusion. According to the existing regulatory documents, it is not recommended to routinely examine all pregnant women with blood group 0(I) for the determination of immune antibodies. It is necessary to identify patients at high risk for the development of HD according to the ABO system and send them to the determination of immune anti-A and anti-B antibodies at 36 weeks.