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.