Rh isoimmunisation in pregnancy -panel
Moderator : Dr Roopam Arora and Dr Dipti Nabh on 20/8/18
Take home message
BG Rh typing should be done in all pregnant women at first visit
All Rh negative women should have husband BG with Rh typing
If Mother Rh negative and father Rh negative no further testing required
Mother Rh negative father Rh positive must get ICT testing done
ABO incompatible couple less chances of alloimmunisation
Critical value of ICT 1:16
Rh negative ICT negative – nonisoimmunised
Repeat ICT 28 weeks if negative Anti D 300mcg and after delivery if baby Rh positive another Anti D 300mcg to be given within 72 hours.
Additional Antenatal Anti D if suspected FMH triggering events – threatened abortion, CVS, Amniocentesis, APH, ECV, blunt trauma
Anti D after spontaneous abortion or MTP medical or surgical 150 mcg if before 12 weeks, 300mcg after 12 weeks.
Post natal anti D reduces Rh alloimmunisation from 15%to 2% and addition of antenatal anti D reduces it to further to 0.2%
Routine antenatal and postnatal prophylaxis with anti D without assessment of FMH by Kleihauer Betke will be effective in 99.3% and only 0.6% will be inadequately covered.
300mcg will neutralise 15 ml Fetal RBC or 30ml Fetal blood.
Avoid FMH at delivery- No fundal pressure, withhold active management of third stage, early clamping, avoid spillage of cord blood at epi site, abdominal packs at LSCS to prevent exposure of Fetal blood.
Rh negataive ICT positive – monthly ICT till 28 weeks then 2 weekly … if more than critical value follow with USG MCA doppler and other features of hydrous on USG. If MCA doppler more than 1.5 MOM need cordocentesis with IUT. And repeat IUT as and when required on strict monitoring and deliver around 35 weeks with steroid cover.
USG finding of hydrops
Ascitis, pericardial effusion, pleural effusion, scalpedema,
Hypertrophy of placenta
Dr . Shadra Jain Dr Meenakshi Sharma