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期刊来源：JAMA

文献发表时间：2023-09-26

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2809809

关键点内容如下：

问题

接受妊娠早期人工流产护理的个体是否有必要使用Rh免疫球蛋白？

调查结果

在这项前瞻性研究中，505/506名参与者（99.8%）接受了妊娠早期人工流产护理，术后胎儿红细胞计数低于公布的Rh致敏阈值。三名参与者在基线时超过阈值；人工流产后没有其他参与者超过这一门槛。

意义

妊娠早期人工流产后不必进行Rh检测或免疫球蛋白注射。

摘要内容如下：

重要性

虽然人群水平的数据表明Rh免疫球蛋白在妊娠12周前是不必要的，但临床证据有限。因此，指南各不相同，造成了围绕Rh检测和治疗的风险和益处的混乱。随着传统临床环境中的堕胎护理越来越难以获得，许多人选择自我管理，并需要了解辅助血型检测是否必要。

目的

确定母体暴露于胎儿红细胞（FRBCs）的频率是否超过已公布的最保守的Rh致敏阈值。

研究设计和参与者

一项多中心、观察性、前瞻性队列研究，使用高通量流式细胞术检测妊娠早期引产（药物或手术）前后配对母体血样中的循环FRBCs包括妊娠12周0天前接受妊娠早期引产的个体。506名接受药物流产（n=319[63.0%]）或手术流产（n=187[37.0%]）的参与者提供了配对血样。

暴露

妊娠早期人工流产

主要结局和措施

主要转归是妊娠早期人工流产后FRBC计数高于致敏阈值（125个FRBC/500万个总RBC）的参与者比例。

结果

在506名参与者中，平均（SD）年龄为27.4（5.5）岁，313人（61.9%）为黑人，123（24.3%）为白人。506名参与者中有3名在基线时FRBC计数升高；其中1例患者流产后FRBC计数升高（0.2%[95%CI，0%-0.93%]）。在妊娠早期人工流产后，没有其他参与者的FRBC计数高于致敏阈值。相对于基线的中位数变化为0个FRBCs，第95和第99百分位数分别为24和35.6个FRBCs。尽管流产前和流产后FRBC计数之间有很强的相关性，但没有其他基线特征与流产后FRBC计数显著相关。

结论和相关性

妊娠早期人工流产不是Rh致敏的危险因素，提示妊娠12周前无需进行Rh检测和治疗。这一证据可用于为妊娠早期人工流产后Rh免疫球蛋白给药的国际指南提供信息。

英文原文如下：

Key Points

Key Points

Question  Is administration of Rh immunoglobulin necessary for individuals undergoing induced first-trimester abortion care?

Findings  In this prospective study, 505/506 participants (99.8%) undergoing induced first-trimester abortion care had postprocedure fetal red blood cell counts below the published threshold for Rh sensitization. Three participants exceeded the threshold at baseline; no additional participants crossed this threshold after induced abortion.

Meaning  Rh testing or immunoglobulin administration following induced first-trimester abortion is unnecessary.

Abstract

Importance  While population-level data suggest Rh immunoglobulin is unnecessary before 12 weeks’ gestation, clinical evidence is limited. Thus, guidelines vary, creating confusion surrounding risks and benefits of Rh testing and treatment. As abortion care in traditional clinical settings becomes harder to access, many people are choosing to self-manage and need to know if ancillary blood type testing is necessary.

Objective  To determine how frequently maternal exposure to fetal red blood cells (fRBCs) exceeds the most conservative published threshold for Rh sensitization in induced first-trimester abortion.

Design, Setting, and Participants  Multicenter, observational, prospective cohort study using high-throughput flow cytometry to detect circulating fRBCs in paired maternal blood samples before and after induced first-trimester abortion (medication or procedural). Individuals undergoing induced first-trimester abortion before 12 weeks 0 days’ gestation were included. Paired blood samples were available from 506 participants who underwent either medical (n = 319 [63.0%]) or procedural (n = 187 [37.0%]) abortion.

Exposure  Induced first-trimester abortion.

Main Outcomes and Measures  The primary outcome was the proportion of participants with fRBC counts above the sensitization threshold (125 fRBCs/5 million total RBCs) after induced first-trimester abortion.

Results  Among the 506 participants, the mean (SD) age was 27.4 (5.5) years, 313 (61.9%) were Black, and 123 (24.3%) were White. Three of the 506 participants had elevated fRBC counts at baseline; 1 of these patients had an elevated fRBC count following the abortion (0.2% [95% CI, 0%-0.93%]). No other participants had elevated fRBC counts above the sensitization threshold after induced first-trimester abortion. The median change from baseline was 0 fRBCs, with upper 95th and 99th percentiles of 24 and 35.6 fRBCs, respectively. Although there was a strong association between the preabortion and postabortion fRBC counts, no other baseline characteristic was significantly associated with postabortion fRBC count.

Conclusions and Relevance  Induced first-trimester abortion is not a risk factor for Rh sensitization, indicating that Rh testing and treatment are unnecessary before 12 weeks’ gestation. This evidence may be used to inform international guidelines for Rh immunoglobulin administration following first-trimester induced abortion.

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