Rh Iso-immunization and Rhogam

If an Rh-negative woman is exposed to Rh-positive blood of fetus in utero, an antigen antibody response occurs, antibodies are formed, and the person is said to be sensitized. Subsequent exposure to Rhpositive blood pregnant with another Rh-positive fetus! can cause a serious reaction resulting in hemolysis of red blood cells of this fetus. "his happens most when an Rh-negative mom carries an Rh-positive fetus, either to term, or to termination by miscarriage or induced abortion. In most cases, even if mom is Rh-negative and the fetus is Rh-positive, the blood of the two never mixes and there is no sensitization. #owever, occasionally, the blood does mix and antibodies are formed. "his can occur in any situation trauma, amniocentesis, blood transfusion to an Rh-negative woman with Rhpositive blood, delivery$! that might allow Rh-positive fetal cells to enter the circulation of an Rh-negative woman. "here are numerous other atypical antigens that also have potential to cause harm to the fetus. "he case of Rh iso-immunization is the most common. %t the first prenatal visit maternal blood type and Rh factor are determined and a routine antibody screen is done indirect &oombs' test!, if mom is Rh-negative. If mom is determined to be sensitized indirect &oombs' test reveals positive results because antibodies were detected!, the fetus is monitored closely for signs of hemolytic disease. "his is usually not the case. If mom is not sensitized, indirect &oombs' test reveals negative results!, mom will be tested again indirect &oombs'! at () wee*s' gestation. If the test remains negative no antibodies detected!, she will be given +,,mcg of Rh immune globulin Rhogam! I-, at () wee*s' gestation, to prevent future sensitization during the pregnancy. She will also be tested for sensitization indirect &oombs'! after any trauma, amnio, chorionic villi sampling, miscarriage, abortion, etc. "he administration of Rhogam will prevent sensitization if mom is not already sensitized and exposure to Rh-positive fetal cells occurs. %fter delivery, another indirect &oombs mom's blood! or direct &oombs ./.'s blood! is

done and if mom remains negative unsensitized!, she will receive Rhogam again, before discharge from the hospital. 0lds (,1(! p. 233-2)1 Summary of tests that help assess ris* of isoimmunization4 Indirect coomb's test o -easures the number of antibodies in the maternal blood 5irect coomb's test o -easures the number of antibodies in the fetal blood 6leihauer-/et*e 6/! test o "his test detects and measures the number of fetal cells in the mother7s blood. o Reported as positive or negative o 8ractitioners may order a higher dose of Rho9%- if positive Summary of when Rho9%- is administered4 %t () wee*s gestation to an Rh negative mother who is not sensitized as evidenced by a negative indirect coomb's test. In an unsensitized Rh negative mother after any procedure:event where maternal:fetal blood could have mixed o /irth o Spontaneous or induced abortion o ;ctopic pregnancy o &<S:%mniocentesis o -ultifetal pregnancy reduction

o 8artial molar pregnancy o 8ercutaneous umbilical blood sampling 8=/S! o %ntepartum hemorrhage o >etal death in the second or third trimester o /lunt trauma to the maternal abdomen Summary of consequences of isoimmunization >etal anemia #ydrops fetalis o a serious fetal condition defined as abnormal accumulation of fluid in ( or more fetal compartments