Rhesus haemolytic disease.

Rhesus (Rh) haemolytic disease has been greatly reduced in incidence by the prophylactic programme with anti-D immunoglobulin, but it will not be eliminated. Even with careful documentation and close liaison between medical, nursing and laboratory personnel, there are occasional failures to administer anti-D to Rh-negative women at risk of sensitization following either delivery (Crowle, 1974) or abortion, or after antenatal events which may be associated with transplacental fetomaternal bleeding, eg, amniocentesis, external version or placental abruption; there are also, of course, women who are already D-sensitized but have not yet completed their reproductive careers, while others have antibodies against Rh antigens other than D; very occasionally Rh sensitization may still result from the transfusion of mismatched blood. For these reasons, we will continue to see small numbers of pregnant women with Rh antibodies, but the multidisciplinary teams responsible for their management and for the care of their babies will find it increasingly difficult to maintain practical experience and expertise. There is therefore a clear need to organize care on a regional basis. In addition to obstetricians and paediatricians with special experience of this problem, multidisciplinary Rh teams must include biochemists, haematologists and blood transfusion specialists, and also radiologists. They must be based on centres with full perinatal facilities, including a neonatal intensive care unit and facilities for both diagnostic ultrasound and intrauterine fetal transfusion. Such a team was established in 1967 at the Royal Maternity Hospital, Belfast, where up to that time six consultant obstetricians had shared the responsibility for the supervision of about two-thirds of the Rh-immunized pregnant women in Northern Ireland, which province has a population of some one and three-quarter million persons, and where severe Rh haemolytic disease is a particularly common problem because of a tendency to very high parity even among women who have already had a succession of unsuccessful pregnancies.