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RH Incompatibility (Final)

This document discusses Rh incompatibility in pregnancy. It begins by presenting a case of a 32 year old pregnant woman at 30 weeks gestation with a history of Rh sensitization during her previous pregnancy. It then provides background on Rh blood types and the pathophysiology of hemolytic disease of the fetus and newborn (HDFN). Potential sensitizing events that can cause a Rh negative mother to develop antibodies against Rh positive fetal blood are outlined. The document discusses investigating a patient's obstetric and blood type history, signs of fetal anemia, diagnostic tests including the Coombs test, and management approaches depending on gestational age. These include RhIgG antibody administration and fetal monitoring and treatment if antibodies are

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58 views17 pages

RH Incompatibility (Final)

This document discusses Rh incompatibility in pregnancy. It begins by presenting a case of a 32 year old pregnant woman at 30 weeks gestation with a history of Rh sensitization during her previous pregnancy. It then provides background on Rh blood types and the pathophysiology of hemolytic disease of the fetus and newborn (HDFN). Potential sensitizing events that can cause a Rh negative mother to develop antibodies against Rh positive fetal blood are outlined. The document discusses investigating a patient's obstetric and blood type history, signs of fetal anemia, diagnostic tests including the Coombs test, and management approaches depending on gestational age. These include RhIgG antibody administration and fetal monitoring and treatment if antibodies are

Uploaded by

samooo67890
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

RH INCOMPATIBILITY

Presenter Sofia Shahzad


Roll no 202
Batch P
CASE:A 32 YEARS OLD G3P2 AT 30 WEEKS OF
GESTATION PRESENTS WITH VAGINAL SPOTTING.
INVESTIGATIONS REVEAL PLACENTA PREVIA
PREVIOUS OBSTETRIC HISTORY REVEALS
ADMINISTRATION OF ANTI-D SERUM DURING LAST
TRIMESTER HER FIRST PREGNANCY WAS
COMPLICATED DUE TO FETO MATERNAL
HEMORRHAGE AFTER AN ACCIDENT
WHAT RISK IS THERE IN PRESENT PREGANCY HOW
WILL YOU MANAGE IT?
INTRODUCTION
Blood group types based on Rh
factor(proteins present of Rbc
membrane)
1. A+ A-
2. B+ B-
3. ABO+ ABO-
4. O+ O-
What is Hemolytic disease of
fetus and newborn(HDFN)?
Three key stage
A rhesus negative mother must conceive a baby who has inherited rhesus positive
blood from father
Fetal cells must gain access to maternal circulation in sufficient
volume to provoke maternal response
Maternal antibodies must cross placenta and cause immune cell
destruction of red cells of fetus
Pathophysiology
Potential sensitising events for
rhesus disease
1) Miscarriage
2) Termination of pregnancy
3) Antepartum haemorrhage
4) Invasive prenatal testing( chorionic villus sampling,
amniocentesis, cordocentesis
4)Delivery
POINTS TO ASK IN
HISTORY
Demography
Previous obstetric history
Blood group of mother and father
History of trauma during pregnancy
Previous pregancies,miscarriage,history
of APH, trauma,
History of Invasive prenatal testing
Delivery methods
Blood transfusions
Rh immunisation history
Antibody screening
SIGNS OF FETAL ANEMIA
Polyhydramnios
Enlarged Fetal heart
Ascites and pericardial effusions
Reduced Fetal movements
Abnormal CTG
Investigations
Blood grouping
Anomaly Scan
Diagnostic testings
Coombs test
DIRECT
INDIRECT
Kleihaur test
MANAGEMENT
Anti D 250IU IS INDICATED IN
MOLAR PREGNANCY ECTOPIC
PREGNANCY OR THERAPEUTIC
TERMINATION OF PREGNANCY
For potentially sensitising events
b/w 12-20 weeks gestation 250IU
should be administered within 72
hours of event
For potentially sensitising events
after 20 weeks gestation a
minimum of 500IU should be
administered
Management of Rh disease in a
sensitized women
Monitor antibody levels every 2-4 weeks from booking
(quantity is described by using titre)

If antibody levels rise baby should be examined for signs of


anemia
in past bilirubin conc of amniotic fluid was determined but this
involves an invasive procedure
In the last decade MCA Doppler is used
A raised peak MCA velocity has a high probability of
anemia
Treatment options include delivery or fetal blood transfusions

Blood transfused should be:


RhD negative
Crossmatched with maternal sample
Densely packed HB
Screened for Infections
COMPLICATIONS
During pregnancy
> Anemia, hyperbilirubenia, jaundice
> Hydrops fetalis
After birth
> Severe hyperbilirubinemia, jaundice,
kernicterus
Principles of Ethics(Autonomy, Beneficience,Non
maleficence, Justice
Screeing and Family Medicine
Counselling
Thankyou :)

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