Dr.P.S.

Hettipathirana
MBBS(COL),MD(Obs & Gyn),MRCOG(UK)
Senior lecturer/ Consultant Obstetrician & Gynaecologist
 ABO antibodies – IgM type
 Genes – C/c,D/d,E/e
 D gene is the significant cause for
isoimmunisation
Antibodies form in only in Rh negative mothers

Exposed to Rh + blood
↓
Form IgM antibodies
↓
Re exposure – Forms IgG antibodies
 Immune complex RBC membrane damage
Extra vascular hemolysis
Anaemia

Compensatory responses

adequate inadequate

Extramedullary
Increased hematopoesis
hematopoesis

hepatosplenomegaly
Minimal or no
fetal effects
Portal hypertension
Liver dysfunction
high output cardiac failure

hydrops death
 If Rh negative
↓
Unexpected antibodies
(At booking Visit)

- ve + ve

Non – sensitised Sensitised

 Re check for unexpected antibodies at 28 weeks ,
if – ve, Antenatal, Anti D immunoglobulin (Rhogam)

 Any sensitising event antenatally give Rhogam

( APH,Truma,ECV,Miscarriage)

 Delivery at term
 After delivery check Newborn blood for
1. Blood group
2. Direct coomb’s
3. Bilirubin
4. Hb
 If baby Rh +ve give Rhogam within 72 hrs
 Kleihauer Betke test – if suspect large mix
up
eg: PPH,Manual removal,Abruption,multiple
pregnancies
 Father’s Rh status
 If + ve – Phenotype → Homozygos / heterozygos
 Check antibody titers
1.Maternal antibody titer - Indirect Coomb’s test
 At regular intervals
 Titer above the critical value indication for invasive testing
 Do not correlate with severity of fetal disease

2.Amount of circulating Anti-D

 Ultrasound scan
Polyhydramnios
Fetal hydrops
Doppler assessment – middle cerebral artery peak systolic flow
(100% accurate)

 Amniocentesis – not practiced now

Spectrophotometric quantification of bilirubin
Lilly – chart
Treatment
 Time the Delivery
 In - utero blood transfusion
Cordocentesis -
Cord blood obtained under ultrasound guidance
from umbilical cord
Blood sent for
◦ Blood group
◦ DCT
◦ Reticulocyte count
◦ Hb

Do in - utero blood transfusion

 Anaemia – blood transfusion

 Hyperbilirubinaemia & jaundice –

Phototheraphy/exchange transfusion
In uteo period mother cleared break down products
But immature neonatal liver unable to cope

 Continued haemolysis in the neonate –

Monitor with haematocrit
as antibodies can persist for weeks

Miscarriage

Ectopic pregnancy

Trauma during pregnancy

Invasive testing during pregnancy —
amniocentesis,CVS
 During delivery – NVD/LSCS
 Antenatal period – via placenta
 Incompatible blood or blood product
transfusion
 Anti-D should be given to all Rh – ve
unsensitised mothers :
◦ Ectopic pregnancy
◦ Any miscarriage with medical or surgical
evacuation
◦ Potentially sensitizing events during pregnancy:
 Invasive prenatal procedures
 antepartum hemorrhage
 External cephalic version
 Abdominal trauma
 Intrauterine death
◦ Antenatal and postnatal prophylaxis
Thank you