Different Rh protein factors of the mother and the fetus, this condition is called Rh incompatibility.

2. INTRODUCTION
 During Pregnancy, the mother and the fetus
have different Rh protein factors, this
condition is called Rh incompatibility.
 Like our blood type, we inherit our Rh factor
type from our parents. Most people are Rh-
positive, but a small percentage of people are
Rh-negative
 Rh factor doesn’t directly affect the health.
 However, Rh factor becomes important
during pregnancy.

3. Rh FACTOR
 • Proteins (antigens) occurring only on surface of
 RBC’s
 • Rh + if proteins present
 • Rh – if proteins absent
 • A+, A-, B+, B-, AB+, AB-, O+, O-
 • Most important for pregnancy
 • Inheritance is Autosomal Dominant
 • 15% Caucasian population are Rh-

4. Rh DISEASE?
 Rhesus disease is a condition where antibodies in a
pregnant woman's blood destroy her baby's blood
cells. It's also known as haemolytic disease of the
fetus and newborn (HDFN).
 If the mother is Rh-negative and her baby is Rh-
positive, during pregnancy (and especially during
labor and delivery) some of the fetus's Rh-positive red
blood cells may get into the mother's bloodstream.
 SENSITIZATION – The process in which mother’s
body will try to fight them off by producing antibodies
against them.

5.  Usually placenta acts as barrier to fetal blood entering
maternal circulation.However,sometimes during
pregnancy or birth,fetomaternal haemorrhage (FMH) can
occur. The woman’s immune system reacts by producing
anti-D antibodies that cause sensitisation

7. EVENTS FOR RHESUS DISEASE
 Miscarriage
 Termination of pregnancy
 Antepartum haemorrhage
 Invasive prenatal testing (amniocentesis cordocentesis
etc.)
 Delivery
 Ectopic pregnancy

9. PATHOPHYSIOLOGY

11. CAUSES
 A difference in blood type between a pregnant woman and
her baby causes Rh incompatibility. The condition occurs if
a woman is Rh-negative and her baby is Rh-positive.
RISK FACTORS
 This may have happened during:
 An earlier pregnancy (usually during delivery).
 An ectopic pregnancy, a miscarriage, or an induced
abortion. (An ectopic pregnancy is a pregnancy that starts
outside of the uterus, or womb.)
 A mismatched blood transfusion or blood and marrow
stem cell transplant.
 An injection or puncture with a needle or other object
containing Rh-positive blood.

12. SYMPTOMS
 Rh incompatibility can cause symptoms ranging from very
mild to deadly.
 Mildest form- Rh incompatibility:
1-Hemolysis (Destruction of the red blood cells) with the
release of free hemoglobin into the infant's circulation.
2- Jaundice (Hemoglobin is converted into, bilirubin which
causes an infant to become yellow.

13.  Severe form- Rh incompatibility
1- Hydrops fetalis (Massive fetal red blood cell
destruction).
2- It causes Severe anemia Fetal heart failure
Death of the infant shortly after delivery.

14.  Total body swelling.
 Respiratory distress (if the infant has been delivered)
 Circulatory collapse.
 Kernicterus. (Neurological syndrome in extremely
jaundiced infants)
 It occurs several days after delivery and is characterized
initially by...
A) Loss of the Moro reflex.
B)Poor Feeding.
C) Decreased activity
 At last it may lead to death of the child immediately after
its birth

15. Diagnosis
MCA doppler
Cell free DNA
Kleihauer test
Amniocentesis and liley graph
Direct coomb’s test

16.  SCREENING TESTS
 ABO & Rh Ab at 1st prenatal visit At 28 weeks
 Postpartum Bleeding
 Antepartum bleeding and before giving any immune globulin
 Neonatal bloods ABO, Rh
 GOLD STANDARD TESTS
• Indirect Coombs:
 mix Rh(D)+ cells with maternal serum
 anti-Rh(D) Ab will adhere
 RBC’s then washed & suspended in
 Coombs serum
 RBC’s coated with Ab will be agglutinated
• Direct Coombs:
 mix infant’s RBC’s with Coombs serum
 maternal Ab present if cells agglutinate

18. Ultrasound Parameters
 Non Reliable Parameters:
 Placental thickness
 Umbilical vein diameter
 Hepatic size
 Splenic size
 Polyhydramnios
 Visualization of walls of fetal bowel from small amounts
intra abdominal fluid may be 1st sign of impending
hydrops
 U/S reliable for hydrops (ascites, pleural effusions, skin
edema) – Hgb < 70

19. COMPLICATIONS
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

20. Management
 Anti D immunoglobulin
 Fetal blood transfusion (fetal Hct <30%)
 Phototherapy

21.  Routes of administration-
 Into umbilical vein at the
point of cord insertion
 Into intrahepatic vein
 Into peritoneal cavity
 Into fetal heart
 Transfused blood-
 RhD negative
 Crossmatched with a maternal sample
 Densely packed (Hb around 30g/L)
 White cell depleted and irradiated
 Screened for infection including CMV

22. PROPHYLACTIC VACCINATIONS
 During every pregnancy
 After a miscarriage or abortion
 After prenatal tests such as amniocentesis
and chorionic villus biopsy
 After injury to the abdomen during
pregnancy