Historical Perspectives: The Underpinnings of Neonatal/Perinatal Medicine

Abstract

The accompanying article by Dr. John Bowman was contributed in response to a request to place his important paper (1) into context. Dr. Bowman is the former Medical Director of the Winnipeg Rh Laboratory and a Distinguished Professor Emeritus at the University of Manitoba. Although not the first to describe the use of Rh immune globulin, the clinicians in Winnipeg were leaders in the use of antenatal prophylaxis. At present, Rh isoimmunization is extremely rare, in large measure because of the pioneers described by Dr. Bowman. Antenatal administration of anti-D immune globulin now is “standard operating procedure,” but this was not always the case. It is important to understand how the problem of Rh isoimmunization has been virtually eliminated from neonatal practice. 1. ↵ Bowman JM, Chown B, Lewis M, Pollock JM. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoc J. 1978;118:623–627 [OpenUrl][1][Abstract][2] # Historical Perspectives: The Underpinnings of Neonatal/Perinatal Medicine {#article-title-2} Rh hemolytic disease was reported initially by a French midwife in 1609. She described the birth of twins: the first, who was pale and bloated with fluid (hydrops fetalis), died within minutes of birth; the second, in much better condition, became deeply jaundiced in the first 3 days after birth, developed rigidity, lay in a position of opisthotonus (kernicterus), and died on the fourth day after birth. Hydrops fetalis and kernicterus were not linked again until 323 years later. In 1932, Diamond and associates determined that they were simply different aspects of a spectrum representing the same disorder. The more severe, hydrops, was characterized by hemolysis of fetal red blood cells that produced severe anemia, followed by hepatosplenomegaly, extramedullary erythropoiesis, and the outpouring of immature nucleated fetal red cells, from which Diamond coined the diagnostic term “erythroblastosis fetalis.” Uncovering the cause of the fetal red blood cell hemolysis had to await the discovery of the Rh blood group system by Landsteiner and Wiener in 1940 and the subsequent determination in 1941 by Levine that the cause of hemolytic … [1]: {openurl}?query=rft.jtitle%253DCanadian%2BMedical%2BAssociation%2BJournal%26rft.stitle%253DCMAJ%26rft.issn%253D0008-4409%26rft.aulast%253DBowman%26rft.auinit1%253DJ.%2BM.%26rft.volume%253D118%26rft.issue%253D6%26rft.spage%253D623%26rft.epage%253D627%26rft.atitle%253DRh%2Bisoimmunization%2Bduring%2Bpregnancy%253A%2Bantenatal%2Bprophylaxis%26rft_id%253Dinfo%253Apmid%252F77714%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=cmaj&resid=118/6/623&atom=%2Fneoreviews%2F3%2F11%2Fe223.atom