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ISOIMMUNIZATION

• Definition

- Is a possibility when a woman who is Rh negative is

sensitized and carrying a fetus who is rh positive.

• Etiology, causes, risk factors

It rarely occurs in a woman's first pregnancy. She only

 becomes sensitized to the fetus's Rh-positive blood

once she comes in contact with it.

• Risk factors:

Being a pregnant woman with Rh-negative blood who

had a prior pregnancy with a fetus that was Rh

 positive

Being a pregnant woman who had a prior bloodtransfusion or amniocentesis

Being a pregnant woman with Rh-negative blood who

did not receive Rh immunization prophylaxis during a

 prior pregnancy with an Rh-positive fetus

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ASSESSMENT

o Rh incompatibility occurs when a woman is Rh

negative, but her fetus has inherited Rh-positive blood from the father. This can also occur during

a miscarriage , induced abortion , or ectopic

 pregnancy .

It is asymptomatic for mothers but possible

complications can lead to hemolytic disease in the

neonate.

Increased concentration (optical density) of bilirubin

and RBC breakdown products in the amniotic fluid.

Has an anti-D antibody titer of 1:16 or greater,

showing Rh sensitization, the fetus will be monitored

every 2 weeks (or more often) to detect presence of 

anemia.

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•  PATHOPHYSIOLOGY

- A female may also become sensitized from receiving blood transfusions with alien Rh antigens, causing

agglutinins to develop.

- Subsequent pregnancy with an Rh-positive fetus triggers

increasing amounts of maternal agglutinating antibodies

to cross the placental barrier, attach to Rh-positive cells

in the fetus, and cause hemolysis and anemia to the

neonate.

- To compensate for this, the fetus steps up the production

of RBCs, and erythroblasts (Immature RBCs) appear in

the fetal circulation.

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INTERVENTIONS/MANAGEMENTS

- Possible early delivery of the fetus

Nursing treatment

- Nurse maintains documentation of blood volumes

exchanged, including the amount of blood withdrawn

and infused.

- Vital signs monitored.

- Nurse encourages the parents to express their thoughts.

- Nurse should praise parents for actions they took to

 prevent any problem, such as frequent antepartum

examinations and blood tests.

Medical treatment

- rhIg or RhoGAM –this prevents the mother’s antibodies

from being able to react to Rh positive cells

- Intrauterine transfusion

o Beforehand, obtain a baseline FHR through electronic

monitoring and explain to the patient the procedure

and its purpose.

o Afterward, carefully observe the patient for uterine

contractions and fluid leakage from the puncture site.

o Monitor FHR for tachycardia or bradycardia.

- amniocentesis or chorionic villi sampling

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- Ultrasonography

- Screening for bloodtype of the pregnant mother.

-

Indirect Coombs test