小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
危险因素
- RhD 阴性母体怀有 RhD 阳性胎儿的既往史
- 胎母输血综合征
- 胎儿有创操作
- 胎盘创伤
- 流产
- 经产
- Rh 免疫预防的疏漏
- 胎头外倒转术
- 葡萄胎妊娠
- 异位妊娠
诊断性检查
首要检查
- 孕妇血型
- 孕妇血清 Rh 抗体筛查
需考虑的检查
- 母体血清抗体滴度
- 父亲血型
- 父亲接合性
- 胎儿超声检查
- 多普勒测速仪测定胎儿大脑中动脉流速（收缩期峰值流速）
- 胎儿血型检定（通过羊膜腔穿刺术或母体循环）
- 胎儿贫血的直接评估
- 玫瑰花环形成试验
- Kleihauer-Betke 试验/流式细胞术
治疗流程
未致敏的 RhD 阴性母体
已致敏的 RhD 阴性母体
幼红细胞增多症新生儿
撰稿人
作者
Andrew D. Hull, MD, FRCOG, FACOG
Professor of Clinical Obstetrics, Gynecology, and Reproductive Sciences
Director, UC San Diego Maternal-Fetal Care and Genetics
Division of Maternal-Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of California San Diego
La Jolla
CA
利益声明
ADH declares that he has no competing interests.
鸣谢
Dr Andrew D. Hull would like to gratefully acknowledge Dr Karen Fung-Kee-Fung and Dr Felipe Moretti, previous contributors to this topic.
利益声明
KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have no competing interests.
同行评议者
Alan Cameron, MD
Honorary Professor of Medicine
University of Glasgow
Glasgow
UK
利益声明
AC is an author of several references cited in this topic.
Liakat Ali Parapia, MD, FRCP
Consultant Hematologist
Bradford Teaching Hospitals NHS Trust
Yorkshire Clinic
Bingley
Bradford
UK
利益声明
LAP declares that he has no competing interests.
Kenneth J. Moise, Jr., MD
Professor of Obstetrics and Gynecology
Texas Children's Fetal Center
Baylor College of Medicine/Texas Children's Hospital
Houston
TX
利益声明
KJM declares that he has no competing interests.
鉴别诊断
- 非免疫性胎儿积液
- 细小病毒感染
- 非 RhD 溶血性疾病
更多 鉴别诊断指南
- 宫外孕和流产：诊断和初始管理
- 孕期保健中预防性使用 RhD 免疫球蛋白
更多 指南
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