![]() ![]() If the neonate is found to be Rh-positive after delivery, those same unsensitized Rh-negative women should be given RhIg within 72 hours of delivery. ![]() If a mother has the potential to have Rh incompatibility during pregnancy, prophylactic RhIg should be administered to unsensitized Rh-negative women at 28 weeks gestation. Furthermore, RhIg immunoprophylaxis has decreased the prevalence of HDN attributed to anti-D antibodies to less than 1%. It has reduced the rate of alloimmunization from 16% to less than 1%. ![]() RhIg consists of anti-Rh D antibodies that target Rh-positive erythrocytes to prevent maternal sensitization. Rh D immunoglobulin (RhIg) has made a significant impact on preventing Rh disease. MCA peak systolic velocity of greater than 1.5 MoM is an indication for cordocentesis to determine fetal hematocrit and the need for intrauterine transfusion.Īs alluded to earlier, one of the main principles of the management of Rh incompatibility is the prevention of maternal sensitization. Fetal surveillance includes serial Middle Cerebral Artery (MCA) dopplers every 1 to 2 weeks beginning at 24 weeks gestation and antenatal testing beginning at 32 weeks gestation. In a patient with a history of HDN, maternal titers are not utilized for determining the appropriate time to initiate fetal surveillance in a subsequent pregnancy. Titers are repeated every month until 24 weeks of gestation and repeated more frequently in the third trimester. In a patient’s first affected pregnancy, surveillance of maternal antibody titers is recommended. Positive screens can be confirmed with the Kleihauer-Betke (KB) test or flow cytometry to determine the percentage of fetal blood cells (based on detecting fetal hemoglobin F) in the maternal circulation and the next steps in management. This assessment can be done with the rosette test for screening. If the father is Rh-positive or the father’s Rh status cannot be determined, then more invasive testing may be needed.įor Rh-negative mothers that have potentially been exposed to fetal Rh-positive blood, one must assess fetomaternal hemorrhage. On the other hand, an Rh-positive father gives the fetus a 50% risk of having Rh-positive erythrocytes and a higher risk for the complications of Rh incompatibility. If the father is also Rh-negative, then there is no risk for alloimmunization and complications of Rh incompatibility. If the Rh-negative mother is antibody negative, paternal Rh testing can be performed as well. This activity reviews the etiology, evaluation, and management of Rh incompatibility, and highlights the role of the interprofessional team in caring for at-risk patients. This is of particular concern if an Rh-negative mother is carrying an Rh-positive fetus, which can result in consequences along the spectrum of HDN ranging from self-limited hemolytic anemia to severe hydrops fetalis. This phenomenon becomes clinically significant if a mother that is Rh-negative becomes sensitized to the D antigen and subsequently, produces anti-D antibodies (i.e., alloimmunization) that can bind to and potentially lead to the destruction of Rh-positive erythrocytes. An individual can be classified as Rh-positive if their erythrocytes express the Rh D antigen individuals without the Rh D antigen are classified as Rh-negative. It is associated with the development of maternal Rh sensitization and hemolytic disease of the neonate (HDN). Rhesus (Rh) incompatibility refers to the discordant pairing of maternal and fetal Rh types. ![]()
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