Rh incompatibility

Last reviewed: 5 Sep 2022
Last updated: 22 Nov 2018

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
More key diagnostic factors

Risk factors

  • maternal RhD-negative status
  • fetomaternal haemorrhage
  • invasive fetal procedures
  • placental trauma
  • abortion
  • multiparity
  • omission of Rh immunoprophylaxis
  • external cephalic version
  • molar pregnancy
  • ectopic pregnancy
More risk factors

Diagnostic investigations

1st investigations to order

  • maternal blood type
  • maternal serum Rh antibody screen
More 1st investigations to order

Investigations to consider

  • maternal serum antibody titre
  • paternal blood type
  • paternal zygosity
  • fetal ultrasound
  • Doppler velocimetry of fetal middle cerebral artery (peak systolic velocity)
  • fetal blood typing (from amniocentesis or maternal circulation)
  • direct assessment of fetal anaemia
  • rosette test
  • Kleihauer-Betke test/flow cytometry
More investigations to consider

Treatment algorithm

INITIAL

RhD-negative mother

ACUTE

neonate with erythroblastosis

Contributors

Authors

Karen Fung-Kee-Fung, MD, FRCSC, MHPE

Associate Professor

Department of OB/GYN

Division of Maternal-Fetal Medicine

The Ottawa Hospital

University of Ottawa

Ottawa

Canada

Disclosures

KFKF is an author of a reference cited in this topic. KFKF declares that she has no competing interests.

Felipe Moretti, MD

Program Director

Maternal-Fetal Medicine Fellowship

Associate Professor

Department of OB/GYN

Division of Maternal-Fetal Medicine

The Ottawa Hospital

University of Ottawa

Ottawa

Canada

Disclosures

FM declares that he has no competing interests.

Peer reviewers

Alan Cameron, MD

Honorary Professor of Medicine

University of Glasgow

Glasgow

UK

Disclosures

AC is an author of several references cited in this monograph.

Liakat Ali Parapia, MD, FRCP

Consultant Hematologist

Bradford Teaching Hospitals NHS Trust

Yorkshire Clinic

Bingley

Bradford

UK

Disclosures

LAP declares that he has no competing interests.

Kenneth J. Moise, Jr., MD

Professor of Obstetrics and Gynecology

Texas Children's Fetal Center

Baylor College of Medicine/Texas Children's Hospital

Houston

TX

Disclosures

KJM declares that he has no competing interests.

  • Rh incompatibility images
  • Differentials

    • Non-immune fetal hydrops
    • Parvovirus infection
    • Non-RhD haemolytic disease
    More Differentials
  • Guidelines

    • ACOG practice bulletin no. 192: management of alloimmunization during pregnancy
    • ACOG practice bulletin no. 181: prevention of Rh D alloimmunization
    More Guidelines
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