Rhesus Negative Pregnancy

Question 1

PREVENTION:

Answer 1

1. Test for D-antibodies in all Rh -ve mothers.
2. Give anti-D to non-sensitised Rh -ve mothers at 28w OR at 28w and 34w.(NICE)
3. Perform Kleihauer-Betke test if in 2nd/3rd trimester:
   - Acid stain to assess proportion of fetal Hb transferred to maternal blood

Question 2

INDICATIONS FOR ANTI-D IMMUNOGLOBULIN ADMINISTRATION:

*Give within 72h

Answer 2

1. Delivery of Rh +ve infant whether live/stillborn
2. TOP
3. Miscarriage if gestation >12w
4. Surgical management of ectopic pregnancy
5. ECV
6. APH
7. Amniocentesis, CVS, FBS

Question 3

TESTS:

Answer 3

1. Cord blood sample at delivery
   - FBC, blood group, Coombs test
2. Kleihauer test
   - Acid stain to assess proportion of fetal Hb in maternal blood

Question 4

FETAL COMPLICATIONS:

Answer 4

1. Oedematous(hydrops fetalis)
2. Jaundice
3. Anaemia
4. Hepatosplenomegaly
5. Heart failure
6. Kernicterus

Treatment: Transfusions, UV phototherapy