Pregnancy In Rh Negative Women

Rh isoimmunisation : GAMS (Gujarat Academy of Medical Science)

Pregnancy in Rh negative women : key points : © Dr Tanmay Mehta 2009       

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Most severly affected : Rh-ve mother with Rh+ve 2nd child Consequence of Rh incompatibility are not serious during 1st pregnancy d/t: Ab not able to cross placenta (AI04) Predisposing factors : APH , CS , post dated pregnancy (dec 97) Type of Hb not affected by Rh immunization : antilewis (dec 97) Serial USG can diagnose hydrops early (nov 99) 28 wk+ amniocentesis show OD of0.20at top of 3rd zone of lilly’s curve : most apprpriateMx : repeat amniocentesis after 1 week Anti D prophylaxis should be given in : (AI 04) o Medical abortion for 63 days pregnancy (mid trimester abortion) o Amniocentesis at 16 weeks (after amniocentesis) o Manual removal of placenta o Vaginal bleeding o ECV Dose of anti D: o After term delivery : 300 microgram Postpartum prophylaxis is best given within 72 hours of delivery , but can be given up to 28 days after delivery Immediate cord ligation is done in : preterm babies , Rh incompatibility Fetomaternal transfusion is detected by/demonstrated in mother by : Kleihauer test (AI 89) Fetomaternal transfusion of >30 ml seen in 10% of women at delivery Indirect coomb’s –detects maternal & direct coomb’s-detects fetal antibodies (AIIMS 87) In Rh –ve mother who has delivered Rh+ve baby,prophylactic anti D is indicated : if Indirect coomb’s test negative In Rh incompatibility prognosis depends upon : S.bilirubin (AI 96) Cx of Rh incompatibility : APH , PPH , PIH (dec 98) Nonimmune hydrops fetalis seen in : alpha thalassemia , parvovirus B -19 ,chromosomal anomaly (Ai 99)syphilis,CMV [Not –Rh incompatibility] Hydrops/erythroblastosis fetalis is NOT seen in : ABO incompatibility Nonimmune hydrops fetalis : (AIIMS 00) o Skin thickness >5mm /skin edema – 1st sign on USG o Placental enlargement o Pericardial/pleural effusion (no cardiomegally) o ascites

Rh isoimmunisation : GAMS (Gujarat Academy of Medical Science)

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