Rh-Isoimmunization in a Primigravida Skydiver

A report describes a case of a 20-year-old female who presented with abdominal cramping. She underwent a urine pregnancy test due to irregular menstruation history. 

Physical examination suggested 32-34 weeks of gestation despite the patient's denial of pregnancy; urine chorionic gonadotrophic hormone testing also came to be positive. Her history revealed her to be a professional skydiving photographer with 100 logged jumps from the start of her pregnancy (by estimated gestational age calculation). She also reported irregular vaginal bleeding every 4 - 6 weeks throughout pregnancy, misinterpreted by her as menstruation. 

Her presenting complaints were active labor, which caused preterm delivery at 34 weeks (gestational age assigned to the newborn at delivery based on neonatal assessment). She showed Port-wine-stained amniotic fluid during spontaneous membrane rupture that indicated chronic abruption. The patient was Rh-negative and had an anti-D antibody, confirming Rh sensitization. 

Placental histology showed a placental mass of 438 g, retroplacental adherent fibrin deposition with placental parenchymal compression. It also showed 40% parenchymal infarct. 

This report reveals that skydiving while pregnant can risk the maternal-fetal unit. Rapid deceleration from parachute canopy deployment and/or repeated impact from landing(s) may cause placental abruption (acute or chronic), Rh-isoimmunization in the susceptible patient, and preterm birth. This case highlights the importance of providing increased access to contraceptives, particularly for individuals engaging in physical risk-taking behaviors.

Chapa HO, Hagar C, Tadjali A, Perli E. Rh-Isoimmunization in a Primigravida Skydiver. J Clin Gynecol Obstet. 2023;12(1):15-18. doi: https://doi.org/10.14740/jcgo845