Rh incompatibility

-negative. Rh incompatibility is a
risk when an Rh negative woman carry a fetus which is Rh positive.
Rh incompatibility results from an antigen-antibody reaction.
When an Rh positive fetus grows inside an Rh negative woman
there is chance for fetal blood enter into maternal circulation at the
time of an abortion or placental separation.
Mother starts producing Rh antibodies against the Rh antigen
entered from fetal blood.
If the pregnancy is continued or at the second time she become
pregnant with an Rh positive fetus, the Rh antibodies cross placenta
and enter fetal circulation destroying fetal RBCs.
The fetus develops anemia, jaundice, cardiac failure (hydrops fetalis)
and neurological damage (kernicterus).
Rh incompatibility
 Assessment
H/O previous blood transfusions
Blood group and Rh status of pregnant woman
Rh antibody titer Indirect Coomb s Test (ICT) for Rh
negative woman at the first pregnancy visit and repeat
at 32-38 weeks of pregnancy.
Normal titer is 0
Minimal ratio 1:8
Amniocentesis and amniotic fluid spectrophotometry
for biliribin
Regular ultrasound from 14-18 weeks onwards look
for fetal ascites and subcutaneous edema (hydrops
fetalis)
 Nursing management
Nursing diagnoses:
1. Health seeking behavior: Information about the purpose of
RhIgG related to the expressed desire to understand the
treatment of Rh incompatibility.

2. Ineffective individual coping related to depression secondary to

the risks for fetal complications.

3. Grieving R/T fetal death.

 Nursing Interventions
Screening for the blood group of all pregnant women.
Arrange for further investigations if the woman is Rh
negative.
Anti D (RhoD or RhoGAM) injection 300µg IM for the mother
at 28 weeks of gestation.
Intrauterine blood transfusion with Rh negative blood in case
of fetal anemia.
Determination of fetal blood group from cord blood at the
time of delivery.
Anti D (RhoD or RhoGAM) injection 300µg IM for the mother
within 72 hours of an abortion, delivery of Rh positive baby
or after procedures like amniocentesis or chorionic villus
sampling.