Corticosteroids for Management of Rh-Isoimmunization : Extended Study in a Tertiary Referral Centre

Background: RhD isoimmunization is a life threatening condition for affected fetuses. It is currently treated only by intrauterine transfusion of packed red blood cells. This procedure required special skill and has potential complications.Aim : The aim of the present study was to evaluate the role of corticosteroids in prevention of fetal anemia due to RhD isoimmunization.Material and Methods: The study was conducted on 15 pregnant patients with RH isoimmunization in Shatby Maternity University Hospital, Alexandria, Egypt, during the period from July 30th 2016 to July 30th 2019. Recruited women received 40 mg oral prednisolone starting from 10th week of gestation. Follow up of Anti-Rh antibodies titer and-from 18 weeks gestation- middle cerebral artery peak systolic velocity (MSA-PSV) was done every 2 weeks. Patients were delivered at 34 weeks gestation by elective caesarean section after receiving 4 doses of dexamethasone to enhance fetal lung maturity.Results: 12 patients continued the trial. Significant reduction was achieved in anti-Rh antibodies titer. Reduction in MSA-PSV was achieved and maintained below 1.5 MOM. Gestational age at delivery ranged from30.3-34 weeks (33.18±1.2 weeks). Fetal eight at delivery ranged from 1550-2270 grams (1978.5±232.5 gm). 9 newborns required NICU admission, only 2 newborns underwent exchange transfusion therapy.Conclusion: In Rh iso-immunization, oral prednisolone proved to have a good rule in preventing fetal anemia and introducing its use should be considered. More studies with bigger sample size are needed to confirm its efficacy