Clinical observations on parturition in cases of Rh-negative immunization.

Abstract

The patho-physiological picture of Rh-immunization and erythroblastosis fetalis has continued to be built up from year to year since Darrow’s assumption (1938) and Levine and Stetson’s (1939) fundamental observation that during pregnancy certain mothers may be immunized by the Mood of their own fetuses. That the appearance of the placenta deviates from normal in fetal erythroblastosis was noted as early as 187s by Jakesch, and again in 1892 by Ballantyne, and in 1910 by Schridde, who had observed large edematous placenta in such cases. We now know that in Rh-negative immunization the placenta presents gross macroscopic and microscopic differences as compared with the placenta in normal pregnancy. In typical cases, the placenta at term is edematous with elevated edges and weighs more than the normal. On account of the edema the placental colour, particularly on the villous side, is lighter than normal. The surface of the placenta, however, is hardly larger than normal. A characteristic of the microscopic picture is large hydropically dilated villi, which have largely maintained their primitive appearance. The normally occurring degeneration of the syncytium is absent and there is often a remarkable persistence of the layer of Langhans (Hellman and Hertig, 1938; Schmidt, 1949; Potter, 1947; N i e 1 sen, 1950). An abnormal production of chorionic gonadotropic hormone in such placentz has also been established (Zilliacus, Widholm, and Pesonen, 1954). There are several reprts of intra-uterine fetal death in cases