Rhesus Isoimmunization

Question 1

Mother’s Rh status?

Answer 1

Rh (-)

Question 2

Fetal Rh status?

Answer 2

Rh (+)

Question 3

What occurs with Rhesus Isoimmunization?

Answer 3

Mother produces antibodies to the fetal Rh D antigen and then they cross the placenta and destroy fetal RBCs

Question 4

If a woman carries the Rh D antigen she is considered?

Answer 4

Rh (+)

Question 5

What antibodies does the Rh (-) mother produce initially? What antibodies will cross the placenta?

Answer 5

IgM

IgG cross placenta

Question 6

What leads to Isoimmunization?

Answer 6

Fetomaternal hemorrhage

– fetal blood enters maternal circulation

Question 7

When does Isoimmunization occur most often?

Answer 7

Vaginal delivery

Question 8

Any fetomaternal hemorrhage can cause Isoimmunization. What can prevent it?

Answer 8

RhoGAM

Question 9

What is RhoGAM?

Answer 9

Anti-D immunoglobulin that decreases RhD in the maternal circulation so she does not make antibodies to it

Question 10

What is RhoGAM?

Answer 10

Anti-D immunoglobulin that decreases RhD in maternal circulation so she does not make antibodies to it

Question 11

When should RhoGAM be administered normally?

Answer 11

1. 28 weeks

2. Within 72 hours after delivery

Question 12

When should RhoGAM be administered normally?

Answer 12

1. 28 weeks

2. Within 72 hours after delivery

Question 13

If there are any factors that increase the chance of fetomaternal hemorrhage, what test can be done to see if another dose of RhoGAM is needed?

Answer 13

Kleinhauer-Betke test

Question 14

What does the Kleinhauer - Betke test do?

Answer 14

Tests for fetal RBCs in maternal circulation

– Another dose of RhoGAM necessary

Question 15

An Rh (-) woman with (+) Anti-D antibodies is considered?

Answer 15

Rh D SENSITIZED

Question 16

If the woman is Rh (-), who should be tested next?

Answer 16

Father of the baby

Question 17

If the Father of the baby is also Rh (-), next step?

Answer 17

NOTHING – baby will be Rh (-) so no treatment is needed

Question 18

If the Father of the baby is Rh D (+), what should be done next?

Answer 18

Determine fetal Rh status

Question 19

What is acquired often to estimate the severity of fetal hemolysis?

Answer 19

Maternal Rh - Antibody titers

Question 20

If the maternal Rh - Antibody titers are < 1:8, what does that indicate?

Answer 20

Fetus is not in jeopardy of hemolysis

Question 21

If the maternal Rh - Antibody titers are > 1:16, what does that indicate?

Answer 21

Fetus is in jeopardy of hemolysis!!!

Question 22

If the Maternal Rh - Antibody titers are > 1:16, what tests should be done next?

Answer 22

1. Fetal US

2. MCA doppler

Question 23

What is the fetus most at risk of with Rhesus Isoimmunization?

Answer 23

Fetal Hydrops

Question 24

What are the signs of Fetal Hydrops?

Answer 24

Ascites
Pleural/Pericardial effusion
Edema
Polyhydramnios

Question 25

What is the purpose of doing a doppler US on the fetal MCA?

Answer 25

The velocity of blood through the MCA detects fetal anemia

Question 26

How often should you check the fetal MCA?

Answer 26

Every 1-2 weeks

Question 27

If the fetal MCA velocity is > ______ it indicates fetal anemia

Answer 27

> 1.5 MoM for gestational age

Question 28

If Fetal Anemia is present, what is the treatment?

Answer 28

Intrauterine RBCs (type O and Rh (-))

Question 29

If Fetal Anemia is present, what is the treatment?

Answer 29

Intrauterine RBCs (type O and Rh (-))

Question 30

Rhesus Isoimmunization occurs with what mother and child?

Answer 30

Mother = Rh (-) for the D antigen
Baby = Rh (+) for the D antigen