RH

occurs when a woman s immune system is sensitized to foreign erythrocyte surface antigen....
If Rh-ve woman married Rh +ve husband got pregnant with Rh +ve foetus ,so foetal RBC leak to maternal circulation recognised as antigen so forming Antibodies return to foetal circulation destroying foetal RBC lead to haemolysis &anaemia if continued causing heart failure and Hydrops fetalis
Circumstances at which sensitisation develop: During smooth uneventful pregnancy.
After miscarriage or ectopic pregnancy.
Any obstetrical procedure.
Given mismatched blood.
Ante partum haemorrhage.
During delivery.
Failure of protection.
Not received.
Diagnosis:
History:
Bl. group & Rh of her & her husband.
Previous pregnancy losses & deliveries.
Received Anti –D or not in previous pregnancy.
Any blood transfusion.
Neonatal exchange transfusion for the neonate.
Physical Exam.:
General :
Abd. Exam.:
Investigations:
Blood group & Rh of the pregnant & her husband
Indirect Coomb’s Test:
Done at booking &28 weeks of gestation
If its negative means no sensitisation.
If positive means sensitised.
If sensitised so perform Antibody Titer.
Ultrasound :
For dating and any abnormality.
Management of Rh-D Negative Non-sensitized Patients :
- For prevention of sensitization:
Rh-immune globulin(Rh-IgG)* 500 IU(300 mcg covers 15 ml foetal cells) is given at 28 -34 weeks .
After delivery cord blood sent for Direct Coomb’s test ,Hb, bilirubin level and blood group& Rh.
If the antibody screen is negative a second dose of Rh-IgG is given if the infant is Rh-positive .