Rh isoimmunisation : GAMS (Gujarat Academy of Medical Science)

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

 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
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