RhD-induced immunogenetic disparity between mother and fetus: medical importance and economic effect of using molecular genetic technology

Abstract

Introduction. The article discusses the problem of timely diagnosis and prevention of Rh-immunity of pregnant women and hemolytic disease of the fetus, which remains relevant today, despite the existence of proven methods of diagnosis, treatment and prevention.Aim: to assess the medico-economic efficiency of non-invasive prenatal diagnostics of the Rh factor (rhesus D antigen, RhD) of the fetus in the mother's blood – RhD-genotyping of the fetus.Materials and Methods. In a retrospective observational study, the results were analyzed of determining the Rh-factor of the fetus in the blood of 4109 Rh-negative pregnant women observed in 41 medical organizations of the Ulyanovsk region in the period 2018–2020. At a gestational age of ≥ 10 weeks, the RhD state of the fetus was determined by polymerase chain reaction. To assess the medical effectiveness of the test, the sensitivity, specificity, predictive value of positive and negative results, and diagnostic accuracy were determined. The data collected during the study were compared with the information obtained after childbirth. To assess the economic efficiency, the difference between the cost of immunization and the cost of determining the D antigen of the Rhesus system (Rh factor) of the fetus was determined.Results. A positive Rh-factor of the fetus was detected in 67.26 % of cases (n = 2793), negative – in 32.74 % (n = 1316). Diagnostic accuracy of the test system "Test-RhD" was 99.40 %, the sensitivity – 99.84 %, the specificity – 97.51 %, the prognostic value of a positive result – 99.43 %, the predictive value of a negative result – 99.28 % with low rates of false positive and false negative results. It has been shown that this study avoids unnecessary immunization costs for all Rh-negative pregnant women.Conclusion. Analysis of the diagnostic characteristics and cost-effectiveness of the RhD test indicate the high medical significance of the method and make it possible to recommend its wider use.