Outcome and follow up
After one day of admission, the patient began to have regular and
painful contractions with cervical dilation until she was diagnosed with
spontaneous frank delivery. An emergency caesarean section was indicated
for established labour, foetal malposition and prematurity.
The perinatal results include the birth of a female neonate weighing
1000 g with evident signs of central predominant hydrops with marked
ascites and placentomegaly. The umbilical arterial pH at birth was 7.31,
and the Apgar test results were 2/2/2. The neonate required intubation
and vasoactive drugs for stabilization. Immediately thereafter, she was
admitted to the neonatal intensive care unit (NICU) was necessary, where
a blood test was performed that revealed severe neonatal anaemia with
haemoglobin of 4.2 g/dL and haematocrit of 14.6%. The neonate received
transfusion with packed red blood cells and ascites drainage with no
clinical improvement.
In the pretransfusion tests of the neonate, the direct Coombs test was
positive (4+), and antibody screening with a 3-cell panel was negative.
Elution to identify the antibodies could not be performed due to the
lack of a sample.
Given the suspicion of undiagnosed isoimmunization, an expanded panel
study of irregular antibodies in the maternal blood was requested,
Isoimmunization with anti-Kpa was identified, with a titre of 1/16.
Subsequently, the erythrocyte phenotype Kpa (+) was confirmed in the
neonate, with maternal Kpa (-), Kpb (+) and paternal Kpa (+),Kbp (+).
Due to haemodynamic instability associated with prematurity and severe
anaemia, the new-born died at 19 hours of age.
The patient continued to present mild hypertension during the immediate
puerperium, which required control with descending doses of enalapril
until it ceased. During the 7 days after delivery, the patient achieved
a negative fluid balance, with an evident decrease in oedema and
normalization of laboratory values and proteinuria.