6. rh & abo incompatibility

Sujata Sahu
MSC Tutor

1. WEL COME

2. Rh - I ncompatibility Presented by Sujata sahu Msc tutor,SNC,Odisha

3. What is Rh factor?

4. This protein does not affect your overall health, but it is important to know your Rh status if you are pregnant. Rh factor can cause complications during pregnancy if you are Rh-negative and your child is Rh-positive. Why is Rh factor important ?

5. Antibody formation can happen after blood transfusions or when fetal blood enters the mother’s circulation Normally, the fetal red cells containing the Rh antigen rarely enter the maternal circulation . But some conditions are there where the risk of chance of fetomternal bleed. What is Rh incompatibility?

6. Ectopic pregnancy Placenta previa Placental abruptio Abdominal/pelvic trauma In – uterofetal death Any invasive obstetric procedure Lack of prenatal care Spontaneous abortion Antepartum bleeding Platelet transfusion Etiology

7. Pathogenesis Rh- negative women Man Rh- positive Mother previously sensitized secondary immune response Fetus Fetus Rh + ve R.B.Cs enter maternal circulation Hemolysis FETUS – unaffected 1 st baby usually escapes mother gets sensitized. ↑ ISO antibody IgG Rh- neg. fetus (no problem) Rh-positive fetus Non sensitized mother primary immune response

8. Rh- incompatibility can cause symptoms ranging from very mild to fatal. Mildest from 1. Hemolysis with the release of free hemoglobin into the infant’s circulation. 2. Jaundice (hb is converted into, bilirubin which cause an infant to became yellow) Clinical manifestation

9. Severe form 1. Hydrops fetalis 2. Icterus gravis neonatrum 3. Congenital anemia 4. kernicterus ( bilirubin induced brain dysfunction) Clinical manifestation

10. Affection of the mother The mother may also be affected somewhat, there is increased incidence of : a) Pre- eclampsia b) Polyhydramnios c) Big size baby with its hazard d) Postpartum hemorrhage due to big placenta e) Maternal syndrome- features are generalized edema & proteinuria Clinical manifestation

11. Obstetrics history a) In a parous woman, a detailed obstetric history has to be taken. b) History of prophylactic administration of anti-D immunoglobulin following abortion or delivery. Physical examination There are no any physical examination seen in this . Diagnosis

12. Also known as Anti globulin test (AGT) Two coomb’s test are: i ) Direct coomb’s test (DCT) ii) Indirect coomb’s test (ICT) Coomb’s test

13. 1. DIRECT COOMB’s TEST To detect the antibodies or complement protein that are bound to the surface of RBCs. 2. INDIRECT COOMB’s TEST It detect antibodies against RBCs that are present unbound in the patient’s serum. Coomb’s test

14. Antibody detection - Detected by indirect coomb’s test - If test negative at 12 th week, it repeated at 28 th week and 36 th week in primi gravida . - If positive then screening of patient. - Quantitative estimation of IgG antibody at weekly intervals. Doppler ultrasound - A value > 1.5 multiples of the median (MOMs) for the corresponding gestational age, predicts moderate to severe fetal anemia. Diagnosis

15. Amniocentesis Amniocentesis and estimation of bilirubin in the amniotic fluid by spectrophotometry are indicated in : Previous history of severely affected baby Father is heterozygous to determine whether the particular baby will be affected or not. Test

16. Management Management Identification S ensitized pregnancy Unsensitized pregnancy Management Management

17. 1.Identification of pregnancies at risk at the initial ANC visit - determine blood group, Rh factor & ICT 2. Repeat ICT at 28 weeks and at 36 weeks, if negative 300 micrograms anti-D at 28 weeks or after any procedure (external version, amniocentesis). . Management of Rh-ve Unsensitized pregnancy

18. After delivery of baby 3. If antibody screen is positive, monitor the newborn for hemolysis and manage next pregnancy as sensitized 4. Provide anti-D within 72 hours, ideally 300 mg given but should be determined by the extent of fetometernal hemorrhage. For abortion of less than 12 weeks gestation the dose is 50 mg. Management of Rh-ve Unsensitized pregnancy

19. Measurement of antibody levels at regular intervals. Amniocentesis for bilirubin levels. Serial ultrasound for detection of hydrops and management of neonatal anemia and hyperbilirubinemia Management of sensitized mother

20. 1.Intrauterine transfusion - Intraperitoneal transfusion -Intravascular transfusion( Umbilical vein transfusion guided by ultrasound) 2. Method of delivery i ) Amniotomy ii) Cesarean section Management of sensitized mother

21. Care during delivery Vaginal delivery - Careful fetal monitoring - Gentle handling of the uterus in the third stage - To take care of postpartum hemorrhage Cesarean section - To avoid spillage of blood into the peritoneal cavity - Routine manual removal of placenta should be withheld Quickly clamping the umbilical cord Treatment

22. 3. Resuscitation In an anemic and premature infant, lung diseases is common, due to: - Surfactant deficiency - Pulmonary edema Exchange transfusion Indications- early : CHb <12 g/dl : Cord bilirubin > 85 mmol /L : Strong + ve coomb’s test Treatment

23. 4. Phototherapy - Placing newborn baby under a halogen or fluorescent lamp with their eyes covered. - During phototherapy, intravenous hydration is required. Treatment

24. To avoid mismatched transfusion To prevent or minimize fetomaternal bleed Precautions during cesarean section Carefully amniocentesis Gently Manual removal of placenta Avoid forcible attempt to perform external version. Prevention

25. 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 Complication

26. SUMMARY

27. Kamini R, “Textbook of midwifery obstetrics for nurses” 2011, ELSEVIER, p.p. 243-244. D.C. dutta , “ A textbook of obstetrics“, 8 th edition, 2015, Jaypee brothers Medical publishers (p) ltd, p.p 386-388. Jacob, A. “Manual of midwifery and gynecological nursing, first edition, 2009, New Delhi , Japee brother Medical publication (p)ltd. P.447. Bibliography