Def

·       A ⊖ SENSITIZED Mom attacking a ⊕ baby (causing Hemolytic Disease of Newborn)

·       Hemolysis + extramedullary RBC production

·       ⤴️ Bilirubin: can be neurotoxic

·       Erythroblastosis fetalis (⤴️ CO)

·       Sensitization happens by the 1st child

Dx

If both mom & dad are Rh ⊖ → Stop. The baby will never be Rh ⊕

Tx

Approach

·       AT 28 weeks

·       w/I 72 h of delivery

·       if there’s maternal-fetal blood mixing for any reason (D&C, CS, surgery)

·       We use Transcarotid US + PUBS

·       If >32 weeks: deliver

·       If <32 weeks: wait + transfuse blood by PUBS

Algorithm

·      If prolonged delivery and you suspect Fetomaternal hemorrhage –> Rosetto test

·      If ⨁ –> KB Test –> then give 300 RHoGAM for every 1.5

·      If ⊖ –> RHoGAM طبيعي زي العادة

·       At 28-32 weeks gestation

·       <72 hours after delivery of Rh(D)-positive infant

·       <72 hours after spontaneous abortion

·       Ectopic pregnancy

·       Threatened abortion

·       Hydatidiform mole

·       CVS, amniocentesis

·       Abdominal trauma

·       2nd- & 3rd-trimester bleeding

·       External cephalic version