Deaths from rhesus haemolytic disease in England and Wales in 1979

Publisher Website
Google Scholar
Abstract
Summary The Office of Population Censuses and Surveys kindly supplied us with copies of the death certificates of the 36 liveborn deaths and 58 stillbirths in 1979 where rhesus haemolytic disease was given as the ‘underlying cause’ in the official returns for the year. In addition we have the certificates of the standard 25 per cent sample (the multiple coded cases) in which rhesus haemolytic disease was given as a ‘contributory’ or ‘antecedent’ cause (5 liveborn and 12 stillbirths); these data being available for research purposes. From a study of all 111 case notes we have determined the circumstances in which the mother has become immunised, and assessed the efficacy of anti-D prophylaxis and the accuracy of death certification. The data were assigned to 9 categories: (1) and (2) 40 of the mothers were immunised before anti-D was available; (3) 10 were immunised during their first pregnancy; (4) 3 produced antibody as a result of stimulation by non-D antigens; (5) 12 cases were failures of anti-D; (6) in 24 there was no record of anti-D having been given when it was indicated; (7) 1 was immunised by blood transfusion; (8) no cases were excluded; details were all available; (9) 21 cases where the deaths were not due to rhesus haemolytic disease Comparing the 1979 results with those of 1977 and 1978 the only marked difference was in the accuracy of death certification, which had improved in 1979 (category 9). The other figures were similar for the 3 years. It appears as if the success of using anti-D has reached a plateau and that further reduction in deaths can only be expected if the prophylaxis is given to all cases at risk and if antenatal as well as postnatal use of anti-D is introduced.