Walker, Fairweather, and Jones: Examination of Liquor Amnii as a Method of Predicting Severity of Haemolytic Disease of Newborn: p. 14l

Abstract

Walker, Fairweather, and Jones: Examination of Liquor Amnii as a Method of Predicting Severity of Haemolytic Disease of Newborn, p. 141. Studies on amniotic fluid specimens collected at 34 to 36 weeks' gestation from 277 immunized Rh-negative women are reported. The value of determinations of hemoglobin, bilirubin, and protein in amniotic fluid in forecasting severe hemolytic disease of the newborn infant is dis(;USsed. Severity of disease in the newborn infant was classified into one of 5 categories, ranging from Rh-negative, unaffected infants to stillbirths with evidence of severe hemolytic disease. The amount of bilirubin present was best evaluated from an interpretation of the spectral absorption curve at a wave length of 450 miL and expressed in units. Protein levels in the amniotic fluid, although correlating well with bilirubin levels, showed many exceptions, and were not felt by the authors to be as valuable as the bilirubin estimate in predicting severity of disease. The presence of high hemoglobin levels in amniotic fluid also was noted in severely affected and stillborn infants, but its absence did not exclude the possibility of severe disease. Therefore, the presence or absence of hemoglobin was disqualified as a reliable indicator for predicting severity of disease. Bilirubin values over 10 units were found in 20 per cent of the specimens, of which 40 per cent resulted in stillbirths and 36 per cent in very severe hemolytic disease; 4 per cent required no treatment. In thf' group with bilirubin levels of less than I 0 units occurred 29 per c-ent of all stillbirths and 60 p<•r c-ent of all severely affected infants. Stillbirths occurred in 3 per cent and vPry sewre disease in 9 per cent of the patients with absolutely dear fluid. The source of bilirubin in the liquor amnii is postulated to he diffusion through the mucosa August 15, 1965 Am. J. Obst. & Gynec,