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Chapter-07 Rh Negative Pregnancy

BOOK TITLE: Clinical Obstetrics—A Case-based Approach

Author
1. Prasad Sudha
2. Goel Meenakshi
ISBN
9789352702749
DOI
10.5005/jp/books/14196_8
Edition
1/e
Publishing Year
2018
Pages
10
Author Affiliations
1. Maulana Azad Medical College, New Delhi, India, Maulana Azad Medical College and LN Hospital, New Delhi, Maulana Azad Medical College and Associated LNJP Hospital, New Delhi, drsprasad@yahoo.com, Delhi, India, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India, Maulana Azad Medical College, New Delhi, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, Maulana Azad Medical College and Loknayak Hospital, New Delhi, India, Maulana Azad Medical College and Associated Lok Nayak Jai Prakash Narayan, (LNJP) Hospital, New Delhi, India, Maulana Azad Medical College and Lok Nayak Jai Prakash Narayan Hospital, New Delhi, India, IVF and Reproductive Biology Centre, Maulana Azad Medical College, New Delhi, India, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India, All India Institute of Medical Sciences, New Delhi, India, Matritava Advanced IVF and Training Centre, New Delhi, India
2. Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
Chapter keywords
Rh factor, Rh negative, fetal blood, alloimmunization, indirect Coomb’s test, Rh immunoglobulin

Abstract

The chapter discusses cases based on Rh negative pregnancy. Most cases of severe fetal anemia requiring antenatal transfusion are attributable to anti-D, anti-Kell, or anti-c alloimmunization. The use of anti-D immunoglobulin has led to a decline in the incidence of Rh alloimmunization from 5–1.7% in last five decades but still it is the most common cause of hemolytic disease of the newborn. When Rh negative maternal blood is exposed to Rh positive fetal blood (RBCs), IgM antibodies are formed in maternal circulation after 6 weeks to 12 months. These IgM antibodies cannot cross the feto-placental barrier and do not harm the fetus. Rh factor is an antigen present on red cell membrane which can stimulate an immune response in an individual who is Rh factor negative. This phenomenon is called alloimmunization. Fetomaternal hemorrhage (FMH) occurs during delivery in almost all Rh negative patients but causes sensitization only in 10–15% of cases. Topics that are covered include role of ultrasound and amniocentesis in the management of Rh alloimmunized pregnancy, indications for intrauterine transfusions, and many others.

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