Immunological investigation of late intra—uterine death: a survey of current practice in the United Kingdom

Summary

The aim of this study was to determine the pattern of investigation for maternal immune disorder after late fetal death. We undertook a survey, by questionnaire, of all the Royal College of Obstetricians and Gynaecologists (R.C.0.G.) district tutors in the United Kingdom. There was a 91.6 per cent response rate. Sixty—nine per cent of units wed written guidelines as suggested by the R.C.O.G. Only 33 per cent of units routinely assay for anticardiolipin antibodies. Antibodies to extractable nuclear antigens (anti—Ro and anti—La) were requested by 8 per cent of units and allo—immune anti—platelet antibodies by I per cent. The most commonly performed investigation was assay of antinuclear antibodies (43 per cent). Routine assays for anti—neutrophil cytopiasin antibodies were performed by 4 per cent of units. rheumatoid factor by 12 per cent and C1 esterase inhibitor by 3 per cent. One—third of units undertook no routine investigations at all. Research—based evidence suggests that. after late fetal death, assays for anti—phospholipid antibodies should be undertaken routinely whilst anti—Ro, anti—La and allo—immune anti—platelet antibodies should be performed if indicated by postniortem findings. All other tests for immune disorder should be abandoned. It is clear that many units are omitting investigations of proven clinical value and that others are performing unnecessary laboratory investigations.