P‐TS‐72 | Regional and Institutional Variation in Managing Rh Disease in Mexico
Bibliographic record
Abstract
Hemolytic disease of the fetus and newborn due to Rhesus blood group antigen (i.e., Rh(D)) develops from an incompatibility between the mother and fetus. Despite having anti-Rh(D) immunoprophylaxis for 50+ years, a major global burden of Rh disease remains, particularly in low/middle-income countries such as Mexico. We examined disparities in allocations of maternal and child health resources, as well as clinical knowledge, to gain insights into the social determinants of health governing Rh disease prevalence in Mexico. An 11-question survey was sent to all members of the Federación Mexicana de Colegios de Obstetricia y Ginecología (FEMECOG) to evaluate knowledge of anti-Rh(D) immunoprophylaxis and Rh disease management. FEMECOG has 7 regions, each containing professional obstetrics associations (Figure A). Responses were separated by region, and chi-square contingency tests were performed to evaluate regional differences. A total of 1512 responses were received from 5083 members. Responses by region varied from 20% to 41% with the most received from Region 7. Significant variations were found within the Mexican healthcare system, particularly regarding providing anti-Rh(D) immunoglobulin to prevent alloimmunization. Most concerning, some providers in Regions 5, 6, and 7 reported never having access to anti-Rh(D) immunoglobulin. In addition, there were differences in access to the drug between public and private hospital settings. Most respondents reported always using anti-Rh(D) immunoglobulin post-partum (lowest compliance 91% in Region 7), while many fewer reported always using it ante-partum (highest use in Region 1 with 26%) and some regions reported never using it in this setting (Region 7 with 26%). Every region had responders report a lack of providers who perform HDFN monitoring (i.e., fetal cerebral middle artery peak systolic velocity) with a range of 4-11% reporting no personnel available in their region. Finally, every region reported a lack of providers who perform intrauterine transfusions, with a range of 18-61% reporting no personnel in their region who offer this service.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".