Document Detail

Is a third-trimester antibody screen in Rh+ women necessary?
MedLine Citation:
PMID:  10621080     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the need for routine third-trimester antibody screening in Rh+ women. STUDY DESIGN: An analytic case-control study. METHODS: We identified Rh+ pregnant women who had received prenatal care and retrospectively analyzed their laboratory data. Patients were grouped into those with a positive third-trimester antibody screen (cases) and those with a negative third-trimester screen (controls). Because entry into a group was decided by the investigators, it could not be randomized. We reviewed the maternal medical records for antibody identification and final pregnancy outcome. We also reviewed the neonatal medical records for evidence of direct Coombs-positive cord blood, anemia, need for transfusion or phototherapy, other medical complications, and death. RESULTS: Using a computerized laboratory database from 2 teaching hospitals, we identified 10,581 obstetric patients who underwent routine first- and third-trimester antibody screening between 1988 and 1997. Of these, 1233 patients were Rh- and 9348 were Rh+. Among the Rh+ patients, 178 (1.9%) had 1 or more atypical antibodies at the first-trimester screen, and 53 (0.6%) had a positive third-trimester antibody screen despite a negative first-trimester screen. Although 6 of these 53 patients (0.06% of the study population) had clinically relevant antibodies for hemolytic disease of the new-born, no significant neonatal sequelae occurred among these 6 patients. CONCLUSION: Based on the patient and hospital records studied, a repeat third-trimester antibody screen for Rh+ patients is clinically and economically unjustified. Eliminating this laboratory test from clinical practice will not adversely affect pregnancy outcomes and will decrease the costs of prenatal care.
J M Rothenberg; B Weirermiller; K Dirig; W W Hurd; J Schilder; A Golichowski
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of managed care     Volume:  5     ISSN:  1088-0224     ISO Abbreviation:  Am J Manag Care     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-11-18     Completed Date:  1999-11-18     Revised Date:  2005-07-26    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1145-50     Citation Subset:  H    
Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, IN, USA.
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MeSH Terms
Autoantibodies / blood*
Case-Control Studies
Cost-Benefit Analysis
Data Collection
Diagnostic Tests, Routine / utilization*
Health Services Research
Hospitals, Teaching
Medical Audit
Pregnancy Outcome
Pregnancy Trimester, Third
Rh-Hr Blood-Group System / immunology*
Unnecessary Procedures
Reg. No./Substance:
0/Autoantibodies; 0/Rh-Hr Blood-Group System

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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