Slides on presentation of rh incompatibility

1. RH INCOMPATIBILITY
Presenter Sofia Shahzad
Roll no 202
Batch P

2. CASE:A 32 YEARS OLD G3P2 AT 30 WEEKS OF
GESTATION PRESENTS WITH VAGINAL SPOTTING.
INVESTIGATIONS REVEAL PLACENTA PREVIA
PREVIOUS OBSTETRIC HISTORY REVEALS
ADMINISTRATION OF ANTI-D SERUM DURING LAST
TRIMESTER HER FIRST PREGNANCY WAS
COMPLICATED DUE TO FETO MATERNAL
HEMORRHAGE AFTER AN ACCIDENT
WHAT RISK IS THERE IN PRESENT PREGANCY HOW
WILL YOU MANAGE IT?

3. INTRODUCTION
Blood group types based on Rh
factor(proteins present of Rbc
membrane)
A+ A-
1.
B+ B-
2.
ABO+ ABO-
3.
O+ O-
4.

4. What is Hemolytic disease of
fetus and newborn(HDFN)?
Three key stage
A rhesus negative mother must conceive a baby who has inherited rhesus positive
blood from father
Fetal cells must gain access to maternal circulation in sufficient
volume to provoke maternal response
Maternal antibodies must cross placenta and cause immune cell
destruction of red cells of fetus

5. Pathophysiology

7. Potential sensitising events for
rhesus disease
1) Miscarriage
2) Termination of pregnancy
3) Antepartum haemorrhage
4) Invasive prenatal testing( chorionic villus sampling,
amniocentesis, cordocentesis
4)Delivery

8. Demography
Previous obstetric history
Blood group of mother and father
History of trauma during pregnancy
Previous pregancies,miscarriage,history
of APH, trauma,
History of Invasive prenatal testing
Delivery methods
Blood transfusions
Rh immunisation history
Antibody screening
POINTS TO ASK IN
HISTORY

9. SIGNS OF FETAL ANEMIA
Polyhydramnios
Enlarged Fetal heart
Ascites and pericardial effusions
Reduced Fetal movements
Abnormal CTG

10. Blood grouping
Anomaly Scan
Diagnostic testings
Coombs test
DIRECT
INDIRECT
Kleihaur test
Investigations

12. Anti D 250IU IS INDICATED IN
MOLAR PREGNANCY ECTOPIC
PREGNANCY OR THERAPEUTIC
TERMINATION OF PREGNANCY
For potentially sensitising events
b/w 12-20 weeks gestation 250IU
should be administered within 72
hours of event
For potentially sensitising events
after 20 weeks gestation a
minimum of 500IU should be
administered
MANAGEMENT

13. Management of Rh disease in a
sensitized women
Monitor antibody levels every 2-4 weeks from booking
(quantity is described by using titre)
If antibody levels rise baby should be examined for signs of
anemia
in past bilirubin conc of amniotic fluid was determined but this
involves an invasive procedure
In the last decade MCA Doppler is used

14. Treatment options include delivery or fetal blood transfusions
Blood transfused should be:
RhD negative
Crossmatched with maternal sample
Densely packed HB
Screened for Infections
A raised peak MCA velocity has a high probability of
anemia

15. During pregnancy
> Anemia, hyperbilirubenia, jaundice
> Hydrops fetalis
After birth
> Severe hyperbilirubinemia, jaundice,
kernicterus
COMPLICATIONS

16. Principles of Ethics(Autonomy, Beneficience,Non
maleficence, Justice
Screeing and Family Medicine
Counselling

17. Thankyou :)