REPRODUCTIVE HISTORIES OF THE MOTHERS OF 322 INFANTS WITH ERYTHROBLASTOSIS

Abstract

One hundred and seventy-five women observed since 1934 who became immunized to Rh at some time during their reproductive careers had a total of 699 pregnancies prior to January 1, 1948. They had 341 pregnancies preceding the birth of the first infant with erythroblastosis. These resulted in seven stillbirths, 13 neonatal deaths, 65 abortions and 256 surviving children. Forty-four of these abortions followed the birth of the last normal child and preceded the birth of the first child with erythroblastosis. The average number of surviving children born to each patient before the birth of an infant with erythroblastosis was 1.4.

The diagnosis of erythroblastosis was made for the first time in seven women in a first pregnancy and 168 women in second or subsequent pregnancies. Four of the women without earlier pregnancies had had transfusions. Of the 178 affected infants 56 died before birth, 60 died after birth and 62 survived.

Ninety-six women had 179 pregnancies following the birth of an infant with erythroblastosis. These have ended in the birth of 3 Rh-negative, 144 Rh-positive infants with erythroblastosis and 32 abortions. Thirteen of the abortions are known to have been induced. Sixty-nine of the Rh-positive infants were stillborn, 63 died and only 12 survived. Three of the latter are known to have brain damage.

The 322 infants with erythroblastosis included 158 males, 132 females and 32 of unknown sex. Twenty-eight percent of affected males and 23% of affected females survived.

Among 131 infants with erythroblastosis delivered in the Chicago Lying-in Hospital the mortality rates were: 38% for 58 infants whose birth had not been immediately preceded by a transfusion, abortion or erythroblastosis in a sibling; 74% for 27 infants whose birth was immediately preceded by an abortion or a transfusion; 90% for 46 infants whose birth was preceded by that of an infant with erythroblastosis.

Among 18,468 deliveries at the Chicago Lying-in Hospital in the last five years the frequency with which erythroblastosis occurred for the first time varied from once in 2,814 deliveries for women in their first pregnancies to 1:172 in second pregnancies and in 1:55 for sixth pregnancies.

In the last two years no live born infant has died of erythroblastosis in this hospital who has not had an older sibling affected by the same disease.

In evaluating any method of treatment the previous reproductive histories of the mothers of the treated infants must be taken into account. In our hands the previous maternal history has been of more value in prognosticating the fate of an infant born to an immunized Rh-negative woman than have changes in maternal antibody titer or differences in the variety of antibodies present.