An article on Rh in compatibility | Rh negative mother

This can occur in Rh negative women following:

The inadvertent administration of Rh positive blood.
Following pregnancy in Rh negative women women having a Rh positive fetus.
Following MTP or abortion due to some fetomaternal leak.
Following manipulation like external version.
Following invasive procedure like amniocentesis or chorion villus sampling.

Prevention, Antenatal, labour management:

Avoid transfusion of Rh positive blood to any Rh negative individual.
Administration of anti – D immunoglobulin after delivery,MTP.

Antenatal Management:

All pregnant women should have their blood ABO and Rh groups determined.
Determined the blood groups of husbands of all Rh negative patients.
Anti D antibody titer in Rh negative women at first visit,28 weeks and 36 weeks.
Administer injection anti D 300 to 500 IU after any procedure like version, amniocentesis.
In immunized women, determine the severity of the iso immunization process by serial estimation of maternal anti D antibody titer.

Labour Management:

The aim should allow labour to progress normally and to end spontaneously with minimal assistance.

In every Rh negative women,it is important to collect sample of the fetal cord blood after delivery to determine the fetal blood groups and Rh types.In case the baby is Rh typing positive to determine whether it is affected the following tests provided the answer:

Direct coomb’s test
Fetal cord blood haemoglobin denotes the degree of anemia at birth.
Bilirubin levels reflect the severity of the haemolytic process.

Serial evaluation of haemoglobin and bilirubin every 2 hours will give the assessment of the severity of iso immunization provide guidelines for further management.

Neonatal outcome:

In this women, the anti D antibodies from the mother crosses the placenta and destroy the fetal RBCs. So the fetus manifests :

Congenital anemia of newborn.
Jaundice in the newborn
Hydrops fetallis

If the infant is treated in time the outcome is satisfactory.

Anemia can be corrected and bilirubin prevented from rising to levels to causing kernicterus.
Treatment of the fetus in utero has improved the prognosis.