ESTRATEGIAS PARA LA PREVENCIÓN DE LA ALOINMUNIZACIÓN RHD EN EL EMBARAZO
Strategies for preventing RhD alloimmunization during pregnancy
DOI:
https://doi.org/10.47187/cssn.Vol17.Iss1.504Palabras clave:
isoinmunización Rh, inmunoglobulinas, factor Rh, eritroblastosis fetalResumen
Introducción: La aloinmunización materno-fetal causada por una incompatibilidad RhD es una condición inmunológica en la cual una gestante RhD negativa genera anticuerpos en contra de los eritrocitos de un feto RhD positivo. Esta respuesta inmunológica es capaz de producir la enfermedad hemolítica del feto o del recién nacido, provocando complicaciones graves como la anemia fetal severa, la hidropesía fetal e inclusive la muerte perinatal. Su prevención efectiva ha sido uno de los mayores logros en obstetricia moderna. Objetivo: Identificar, a partir de la evidencia científica más actualizada, las estrategias más efectivas para la prevención de la aloinmunización RhD en el embarazo. Metodología: Se realizó una revisión narrativa en bases de datos biomédicas (PubMed, UpToDate, DynaMed) y guías de la FIGO, seleccionando 36 documentos publicados entre 2020 y 2025 que abordaran prevención y manejo clínico. Resultados: De un total de 1.010 documentos encontrados, se seleccionaron 36 artículos que cumplen con los criterios de inclusión y abordan sobre prevención, diagnóstico y manejo clínico. Discusión: La administración profiláctica de inmunoglobulina anti-D en gestantes no sensibilizadas ha reducido significativamente la incidencia de aloinmunización, y el riesgo perinatal. Conclusión: La prevención de la aloinmunización RhD es esencial para proteger la salud fetal y neonatal, y debe mantenerse como una prioridad en el cuidado obstétrico
Abstract
Introduction: Maternal-fetal alloimmunization caused by RhD incompatibility is an immunological condition in which an RhD-negative pregnant woman produces antibodies against the red blood cells of an RhD-positive fetus. This immune response can lead to hemolytic disease of the fetus or newborn, resulting in serious complications such as severe fetal anemia, hydrops fetalis, and even perinatal death. Its effective prevention has been one of the greatest achievements in modern obstetrics. Objective: To identify, based on the most up-to-date scientific evidence, the most effective strategies for preventing RhD alloimmunization during pregnancy. Methodology: A narrative review was conducted using biomedical databases (PubMed, UpToDate, DynaMed) and FIGO guidelines, selecting 36 documents published between 2020 and 2025 that addressed prevention and clinical management. Results: Out of a total of 1,010 documents identified, 36 articles met the inclusion criteria and addressed aspects of prevention, diagnosis, and clinical management. Discussion: The prophylactic administration of anti-D immunoglobulin to non-sensitized pregnant women has significantly reduced the incidence of alloimmunization and associated perinatal risks. Conclusion: Prophylactic administration of anti-D immunoglobulin in non-sensitized pregnant women has significantly reduced the incidence of alloimmunization and perinatal risk.
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1. Moise Jr K. RhD alloimmunization in pregnancy: Overview - UpToDate [Internet]. UpToDate. 2024 [cited 2025 Apr 10]. Available from: https://www.uptodate.com/contents/ rhd-alloimmunization-in-pregnancy-overview/print?search=aloinmunización+rhd+durante+el+embarazo&source=search_ result&selectedTitle=2~150&usage_type=default&display_rank=2
2. Benavides-Serralde JA, Buitrago-Leal M, Molina Giraldo S, Benavides Calvache JP, Rivera Tobar I, López Rodríguez MJ, et al. Consenso colombiano de diagnóstico, prevención y manejo de la enfermedad Rh. Rev Colomb Obstet Ginecol [Internet]. 2024 Sep 30 [cited 2025 Apr 9];75(3):4142. Available from: https://pmc.ncbi. nlm.nih.gov/articles/PMC11457932/
3. Júnior MDC, Sosa SE y., Fernandes M, do Carmo L, de Oliveira RW, Kanevsky G. Hemolytic disease of the fetus and newborn and Rhesus alloimmunization in Latin American countries: a scoping review. BMC Pregnancy Childbirth [Internet]. 2024 Dec 1 [cited 2025 Apr 9];24(1):830. Available from: https://pmc.ncbi. nlm.nih.gov/articles/PMC11660609/
4. (Quality) OH. Noninvasive Fetal RhD Blood Group Genotyping: A Health Technology Assessment. Ont Health Technol Assess Ser [Internet]. 2020 [cited 2025 Apr 9];20(15):1. articles/PMC7670296/
5. Sugrue RP, Moise KJ, Federspiel JJ, Abels E, Louie JZ, Chen Z, et al. Maternal red blood cell alloimmunization prevalence in the United States. Blood Adv [Internet]. 2024 Aug 27 [cited 2025 Apr 9];8(16):4311. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC11372799/
6. Calhoun D, Marvin Bahr T. Alloimmune hemolytic disease of the newborn: Postnatal diagnosis and management [Internet]. UpToDate. 2024 [cited 2025 May 3]. Available from: https://www.uptodate.com/contents/alloimmune-
hemolytic-disease-of-the-newborn-postnatal-diagnosis-and-management/print?search=incompatibilidad rh&source=-
search_result&selectedTitle=3~150&usage_type=default&display_rank=3
7. Moise Jr K. RhD alloimmunization: Prevention in pregnant and postpartum patients [Internet]. UpToDate. 2024 [cited 2025 Apr 10]. Available from: https://www.uptodate.com/contents/ rhd-alloimmunization-prevention-in-pregnant-and-postpartum-patients/print?search=aloinmunización+rhd+durante+el+embarazo&source=search_result&selectedTitle=3~150&usage_type=default&display_ rank=3
8. Moise Jr K. RhD alloimmunization in pregnancy: Management - UpToDate [Internet]. UpToDate. 2025 [cited 2025 Apr 10]. Available from: https://www.uptodate.com/contents/ rhd-alloimmunization-in-pregnancy-management/print?search=aloinmunización+rhd+durante+el+embarazo&source=search_ result&selectedTitle=1~150&usage_type=default&display_rank=1
9. Minuk L, Clarke G, Lieberman L. Approach to red blood cell antibody testing during pregnancy: Answers to commonly asked questions. Can Fam Physician [Internet]. 2020 Jul 1 [cited 2025 Apr 9];66(7):491. Available from: https:// pmc.ncbi.nlm.nih.gov/articles/PMC7365158/
10. Neamţu SD, Novac MB, Neamţu AV, Stanca ID, Boldeanu MV, Gluhovschi A, et al. Fetal-maternal incompatibility in the Rh system. Rh isoimmunization associated with hereditary spherocytosis: case presentation and review of the literature. Rom J Morphol Embryol [Internet]. 2022 Jan 1 [cited 2025 Apr 9];63(1):229– nih.gov/36074689/
11. Pegoraro V, Urbinati D, Visser GHA, Di Renzo GC, Zipursky A, Stotler BA, et al. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One [Internet]. 2020 Jul 1 [cited 2025 Apr 9];15(7). Available from: https://pubmed.ncbi.nlm.nih.gov/32687543/
12. Stensrud M, Bævre MS, Alm IM, Wong HY, Herud I, Jacobsen B, et al. Terminating Routine Cord Blood RhD Typing of the Newborns to Guide Postnatal Anti-D Immunoglobulin Prophylaxis Based on the Results of Fetal RHD
Genotyping. Fetal Diagn Ther [Internet]. 2023 Oct 1 [cited 2025 Apr 9];50(4):276. Available
from: https://pmc.ncbi.nlm.nih.gov/articles/ PMC10614222/
13. Hamel C, Esmaeilisaraji L, Thuku M, Michaud A, Sikora L, Fung-Kee-Fung K. Antenatal and postpartum prevention of Rh alloimmunization: A systematic review and GRADE analysis. PLoS One [Internet]. 2020 Sep 1 [cited 2025 Apr 9];15(9):e0238844. Available
from: https://pmc.ncbi.nlm.nih.gov/articles/ PMC7482964/
14. Horvath S, Huang ZY, Koelper NC, Martinez C, Tsao PY, Zhao L, et al. Induced Abortion and the Risk of Rh Sensitization. JAMA [Internet]. 2023 Sep 26 [cited 2025 Apr 9];330(12):1167. Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC10524155/
15. Jernman R, Isaksson C, Haimila K, Kuosmanen M, Mäkikallio-Anttila K, Toivonen S, et al. Time points and risk factors for RhD immunizations after the implementation of targeted routine antenatal anti-D prophylaxis: A retrospective nationwide cohort study. Acta Obstet Gynecol Scand [Internet]. 2021 Oct 1 [cited 2025 Apr 9];100(10):1868–75. Available from: https://onlinelibrary.wiley.com/doi/ full/10.1111/aogs.14216
16. Uhl L. Red blood cell antigens and antibodies [Internet]. UpToDate. 2025 [cited 2025 May 3]. Available from: https://www.uptodate.com/ contents/red-blood-cell-antigens-and-antibodies/print?search=incompatibilidad rh&source=search_result&selectedTitle=6~150&usage_ type=default&display_rank=6
17. Visser GHA, Thommesen T, Di Renzo GC, Nassar AH, Spitalnik SL, Visser GHA, et al. FIGO/ICM guidelines for preventing Rhesus disease: A call to action. Int J Gynecol Obstet [Internet]. 2021 Feb 1 [cited 2025 May 3];152(2):144–7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/
18. Jeong IH, Yu SH, Kim TY, Oh SY, Cho D. Guide to Rho(D) Immune Globulin in Women With Molecularly Defined Asian-type DEL (c.1227G>A). Ann Lab Med [Internet]. 2024 [cited 2025 Apr 9];44(4):307–13. Available
from: https://pmc.ncbi.nlm.nih.gov/articles/ PMC10961623/
19. Slootweg YM, Zwiers C, Koelewijn JM, van der Schoot E, Oepkes D, van Kamp IL, et al. Risk factors for RhD immunisation in a high coverage prevention programme of antenatal and postnatal RhIg: a nationwide cohort study. Bjog [Internet]. 2022 Sep 1 [cited 2025 Apr 9];129(10):1721. Available from: https://pmc. ncbi.nlm.nih.gov/articles/PMC9543810/
20. DynaMed. Fetomaternal Hemorrhage [Internet]. EBSCO Information Services. 2025 [cited 2025 May 3]. Available from: https://www.dynamed.com/condition/fetomaternal-hemorrhage#GUID-BD-
967FE8-7F79-4330-AE3E-8A8D1B2DE8A6
21. Teng J, Wickman L, Reilly M, Nemeth A, Fischler B, Bohlin K, et al. Population-based incidence and risk factors for cholestasis in hemolytic disease of the fetus and newborn. J Perinatol [Internet]. 2022 Jun 1 [cited 2025 Apr 9];42(6):702. Available from: https://pmc.ncbi. nlm.nih.gov/articles/PMC9184269/
22. Yilmaz Yegit C, Yasa B, Ince EZ, Sarac Sivrikoz T, Coban A. An ongoing problem: Rhesus hemolytic disease of the newborn - A decade of experience in a single centre. Pediatr Neonatol [Internet]. 2024 Sep 1 [cited 2025 Apr 9];65(5):482–6. Available from: https://www.pediatr-neonatol.com/action/ showFullText?pii=S1875957224000226
23. Guo D, He S, Lin N, Dai Y, Li Y, Xu L, et al. Genetic disorders and pregnancy outcomes of non-immune hydrops fetalis in a tertiary referral center. BMC Med Genomics [Internet]. 2023 Dec 1 [cited 2025 Apr 9];16(1):83. Available
from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10116719/
24. Şavkli AÖ, Çetin BA, Acar Z, Özköse Z, Behram M, Çaypinar SS, et al. Perinatal outcomes of intrauterine transfusion for foetal anaemia due to red blood cell alloimmunisation. J Obstet Gynaecol (Lahore) [Internet]. 2020 Jul 3 [cited
2025 Apr 9];40(5):649–53. Available from: https://www.tandfonline.com/doi/abs/10.1080/01443615.2019.1647521
25. Riis SST, Joergensen MH, Rasmussen KF, Husby S, Hasselby JP, Borgwardt L, et al. Transient congenital hyperinsulinism and hemolytic disease of a newborn despite rhesus D prophylaxis: a case report. J Med Case Rep [Internet]. 2021 Dec 1 [cited 2025 Apr 9];15(1):573. Available from: https://pmc.ncbi.nlm.nih.gov/ articles/PMC8626963/
26. Ding JC, Montemayor-Garcia C, Stotler BA, Spitalnik SL, Ayala Méndez JA. Rh disease in Mexico: evaluating regional and institutional differences in treatment availability and disease management. Blood Transfus [Internet]. 2024 Mar 1 [cited 2025 Apr 9];23(2):109. Available from: https://pmc.ncbi.nlm.nih.gov/articles/ PMC11925255/
27. DynaMed. Alloimmune Hemolytic Disease of the Newborn (HDN) [Internet]. EBSCO Information Services. 2025 [cited 2025 May 3]. Available from: https://www.dynamed.com/ condition/alloimmune-hemolytic-diseaseof-the-newborn-hdn#GUID-BA1285F7-8A92-4A00-900C-B6FF8FAF0BEF
28. Coucheron T, Uhrynowska M, Guz K, Orzińska A, Debska M, Gierszon A, et al. What’s with the boys? Lower birth weight in boys from HPA-1a alloimmunized pregnancies – New insights from a large prospective screening study in Poland. J Reprod Immunol. 2023 Dec 1;160:104168
29. Sudha S, Sahoo N, Tripathy S, Panda J, Kumar S. Necessity of Improvised Antenatal Testing for Rh Isoimmunization - Exploring From a Case Series - PubMed [Internet]. Indian Pediatrics. 2024 [cited 2025 Apr 9]. Available from: https://pubmed.ncbi.nlm.nih.gov/38584407/
30. DynaMed. Routine Prenatal Care [Internet]. EBSCO Information Services. 2025 [cited 2025 May 3]. Available from: https://www.dynamed.com/management/routine-prenatalcare-36#GUID-D91EC9A1-6855-4984-9754-ADBA113C1065
31. Ryczek E, White J, Carolan-Rees G. Implementation of high‐throughput non‐invasive prenatal testing for fetal RHD genotype testing in England: Results of a cross‐sectional survey of maternity units and expert interviews. Transfus
Med [Internet]. 2020 Aug 1 [cited 2025 Apr 9];30(4):287. Available from: https://pmc.ncbi.nlm.nih.gov/articles/MC7496714/
32. Moc Willeford C, Shetty K, Sheridan D, Engler F. Informing pregnancy dose via target‐mediated drug disposition modeling and simulations for a recombinant human monoclonal antibody. CPT Pharmacometrics Syst Pharmacol [Internet]. 2024 Nov 1 [cited 2025 Apr 9];13(11):2002. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11578131/
33. Fyfe TM, Lavoie JG, Payne GW, Banner D. Rhesus D factor (RhD) negative women’s experiences with pregnancy: An interpretive description. Women and Birth [Internet]. 2020 Nov 1 [cited 2025 Apr 9];33(6):e511–8. Available from: https://www-sciencedirect-com. proxy.espoch.edu.ec/science/article/pii/ S1871519219304652?via%3Dihub
34. Sørensen K, Stjern HE, Karlsen BAG, Tomter G, Ystad I, Herud I, et al. Following targeted routine antenatal anti-D prophylaxis, almost half of the pregnant women had undetectable anti-D prophylaxis at delivery. Acta Obstet Gynecol Scand [Internet]. 2022 Apr 1 [cited 2025 Apr 9];101(4):431. Available from: https://pmc.ncbi. nlm.nih.gov/articles/PMC9564431/
35. Flynn AN, Hoffman E, Murphy C, Jen A, Schreiber CA, Roe AH. Fetomaternal hemorrhage assessment in Rh-negative patients undergoing dilation and evacuation between 20 and 24 weeks’ gestational age: A retrospective cohort study. Contraception [Internet]. 2022 Jun 1 [cited 2025 Apr 9];110:27–9. Available from: https://www.contraceptionjournal.org/
action/showFullText?pii=S0010782422000336
36. Chan MC, Gill RK, Kim CR. Rhesus isoimmunisation in unsensitised RhD-negative individuals seeking abortion at less than 12 weeks’ gestation: a systematic review. BMJ Sex Reprod Heal [Internet]. 2021 Jul 1 [cited 2025 Apr 9];48(3):163. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9279745/
37. Visser GHA, Thommesen T, Di Renzo GC, Nassar AH, Spitalnik SL, Visser GHA, et al. FIGO/ICM guidelines for preventing Rhesus disease: A call to action. Int J Gynaecol Obstet [Internet]. 2021 Feb 1 [cited 2025 Apr 9];152(2):144. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/
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