RH INCOMPATIBILITY
INTRODUCTION
During pregnancy , the mother and the fetus have different Rh
protein factors , this condition is called RH INCOMPATIBILITY
Like our blood type , we inherit our Rh factors type from our
parents . Most people are Rh positive , but a small percentage of
people are Rh negative . Rh factors doesn’t directly affect the
health . However , Rh factor becomes important during
pregnancy.
DEFINITION
The disease range from mild to severe , and typically occurs only
in some second or subsequent pregnancies of Rh negative women
where the fetus’s father is Rh positive , leading to a
Rh+pregnancy .
CAUSES OF RH INCOMPATIBILITY
A different in blood type between a pregnant
women and her baby causes Rh incompatibility the conditions
occurs if a women is Rh negative and her baby is Rh positive .
RISK FACTORS OF RH
INCOMPATIBILITY
• An earlier pregnancy ( usually during delivery ).
• An ectopic pregnancy , a miscarriage , or an induced abortion , ( an
ectopic pregnancy is a pregnancy that starts outside of the uterus , or
womb )
• A mismatched blood transfusion or blood and marrow stem cell
transplant.
• An injection or puncture with a needle or other object containing Rh-
positive blood.
PATHOPHYSIOLOGY
Rh – negative mother Rh – positive mother
Maternal antibody screen 20, 24,
28 weeks of gestation.
Negative Positive
Administration of 300 ug of Manage as Rh sensitized
immunoglobulins at 28 weeks pregnancy
At delivery of the baby the Rh Amniocentesis for estimation of
status of the newborn to be fetal bilirubin levels
checked
Optimal density at
450 nm
Rh – negative baby Rh – positive baby
Further management
based on fetal
Administration of condition and is
No further
300 ug of anti –d determined by :
treatment
within 72 hours of Percutaneous
required
delivery. umbilical blood
sampling
Amniotic fluid
analysis
Ultrasound
examination
LILLY’S CHART
SIGNS AND SYMPTOMS
Hemolysis
Jaundice
Total body swelling
Respiratory distress
Circulatory collapse
Kernicterus
It occurs several days after delivery and is characterized initially by
A).poor feeding
B).Decreased activity
DIAGNOSIS
• MCA doppler
• Cell free DNA
• Kleihauer test
• Amniocentesis and liley graph
• Direct coomb’s test
SCREENING TESTS
• ABO & Rh Ab at 1st prenatal visit at 28 weeks
• Postpartum bleeding
• Antepartum bleeding and before giving any immune globulin
• Neonatal bloods ABO , Rh
• GOLD STANDARD TESTS
• INDIRECT COOMBS
• Mix Rh (D)+cells with maternal serum
CONT….
Anti-Rh (D) Ab will adhere.
RBC’s then washed 7 suspected
Coombs serum
RBC’S Coated With Ab will be agglutinated.
DIRECT COOMBS
Mix infant’s RBC’S with coombs serum
Maternal Ab present if cells agglitinate.
ULTRASOUND PARAMETERS
• NON RELIABLE PARAMETERS
• Placental thickness
• Umbilical vein diameter
• Hepatic size
• Splenic size
• Polyhydramnios
• Visualization of walls of fetal bowel from small amounts intra abdominal fluid
may be 1st sign of impending hydrops.
MANAGEMENT
• Anti D immunoglobulin
• Fetal blood transfusion ( fetal Hct<30%)
• phototherapy
ROUTES OF ADMINISTRATION
• Into umbilical vein at the point of cord insertion .
• Into intrahepatic vein
• Into peritoneal cavity
• Into fetal heart
• TRANSFUSED BLOOD
• RhD negative
• Crossmatched with a maternal sample
CONT…..
• Densely packed ( Hb around 30G\L)
• White cell depleted and irradiated
• Screened for infection including CMV
• PROPHYLACTIC VACCINATION
• During every pregnancy
• After a miscarriage or abortion
• After prenatal tests such as amniocentesis and chorionic villus biopsy
• After injury to the abdomen during pregnancy
TREATMENTS
• GOALS OF TREATMENT;
• The goals of treating Rh incompatibility are to ensure that baby is healthy
and to lower mothers risk for the condition in future pregnancies.
COMPLICATION
• DURING PREGNANCY
• Mild anemia , hyperbilirubinemia and jaundice .
• Severe anemia with enlargement of the liver and spleen .
• Hydrops fetalis
• AFTER BIRTH
• Severe hyperbilirubinemia And jaundice
• Kernicterus.
SUMMARY
• Rh incompatibility occurs when the mothers blood type is Rh negative and
her fetus blood type is Rh positive . Antibodies from Rh negative mother
may enter the blood stream of her unborn Rh positive infant , damaging
the red blood cells.
CONCLUSION
• If the mothers is Rh-negative and the baby is Rh-positive , her immune
system may produce antibodies against the baby’s Rh –positive red blood
cells , this can lead to hemolytic disease of the newborn , condition where
the baby’s red blood cells are destroyed , potentially causing jaundice ,
anemia or even more severe complications like heart failure.
THEROY APPLICATION
GENERAL THEORY SYSTEM
THE STUDENT ARE HAVING LECTURE CLASS ON Rh
THE STUDENTS GAINED
INADEQUATE KNOWLEDGE INCOMPATIBILITY BY PPT ,
KNOWLEDGE REGARDING
REGARDING Rh HAND OUT PAMPLET ,
Rh INCOMPATIBILITY
INCOMPATIBILITY CHARTS AND BLACK BOARD
FEED BACK
JOURNAL REFERENCE
TITLE ;
• The rhesus incompatible pregnancy and its consequences for affected
fetuses and neonates.
• ABSTRACT ;
• Rhesus incompatibility in pregnancy may result in hemolytic disease of
the fetus and new born ( HDFN ) This review discusses the fetal , neonatal
and long term consewuences of HDFN and its management untreated , the
fetal and neonatal prognosis of HDFN is poor.