Rhesus Isoimmunization and its Management

Rh isoimmunization is defined as the maternal production of Rh antibodies in response to the presence of Rh antigens on fetal red blood cells, typically occurring when an Rh-negative mother carries an Rh-positive fetus. This sensitization can lead to the production of IgG antibodies that cross the placenta in subsequent pregnancies, resulting in fetal red cell agglutination and hemolysis.
We go through clinical features in baby and mother and further management and prevention

1. Name: Sheba Roymon
Group 501
Gynecology individual work 1
Lecturer: Dr. Tatevik Arshakyan
Rhesus
Isoimmunization

2. Rhesus Factor

3. Rh
isoimmunization

4. ●Fetal-maternal hemorrhage: less than 1
mL of Rh-positive blood was shown to
sensitize
●Once sensitized, it takes approximately
one month for Rh antibodies in the
maternal circulation to equilibrate in the
fetal circulation.
●sensitization occurs during delivery
●The risk and severity of sensitization
response increases with each
subsequent pregnancy involving a fetus
with Rh-positive blood
●The important Rh antigen responsible for
majority of cases of severe Rh
isoimmunization is Rhesus D antigen. The
other atypical Rh antigens with a
potential to cause severe
isoimmunization are c, E and Kell
antigens. Rest of the Rh antigens (Duffy,
Kidd, M and S) rarely cause significant
problems.
Volume of
transplacental
hemorrhage

Concurrent
presence of ABO
incompatibility

Extent of the
maternal
immune
response

Risk of
sensitizati
on

5. low levels of glucuronyl transferase in
the infant preclude the conjugation of
large amounts of bilirubin and may result
in dangerously elevated levels of serum
bilirubin and severe jaundice
Manifestations
anemia
hyperbilirubinemia
Kernicterus
erythroblastosis fetalis
hydrops fetalis
placentomegaly, polyhydramnios,
preclampsia,maternal syndrome

7. Laboratory Studies

Rosette screening test
Kleihauer-Betke acid
elution test
Serial amniocentesis
Fetal middle cerebral
arterial (MCA)
measure hematocrit and hemoglobin
levels, perform a serum bilirubin
analysis, obtain a blood smear, and
perform an indirect Coombs test

10. Management
Initial
anti-D immunoglobulins to
the mother
If ICT is negative at the first visit, it is repeated
at four weekly interval and if it remains
negative on subsequent testing, prophylactic
dose of anti-D immunoglobulin is given (300
µg deep intramuscularly) at 28–32 week of
pregnancy
Postpartum
Prophylaxis
prophylactic anti-D within
72 h of birth
120–150 µg of intramuscular anti-D injection is given for the following
obstetric conditions within 12 week of pregnancy: Threatened abortion;
miscarriage; induced abortion; ectopic pregnancy; molar pregnancy; and
chorionic villus sampling.
After 12 week of pregnancy, 300 µg of intramuscular anti-D for
following conditions: All above conditions after 12 week;
amniocentesis; external cephalic version; antepartum
hemorrhage; retained placenta; and blunt trauma over the
abdomen.

11. Intrauterine Transfusion (IUT)

IUT is most effective in management of isoimmunized pregnancy where fetus is anemic and not mature enough to
be delivered.

12. resources
●https://link.springer.com/article/10.1007/s40556-014-00
13-z#Tab1
●Fetal-Maternal Hemorrhage: A Case and Literature Review
●Rh blood group | Definition, Rh Factor, & Rh Incompatibility |
Britannica
●Rh blood group system - Wikipedia
●https://www.winchesterhospital.org/health-library/articl
e?id=11595#:~:text=Rh%20incompatibility%20is%20wh
en%20a,harm%20the%20baby's%20blood%20cells.
●https://www.wnyurology.com/content.aspx?chunkiid=11
595
●

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