Summary
Definition
History and exam
Key diagnostic factors
- presence of risk 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
Diagnostic investigations
1st investigations to order
- maternal blood type
- maternal serum Rh antibody screen
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
Treatment algorithm
RhD-negative mother
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.
Differentials
- Non-immune fetal hydrops
- Parvovirus infection
- Non-RhD haemolytic disease
More DifferentialsGuidelines
- ACOG practice bulletin no. 192: management of alloimmunization during pregnancy
- ACOG practice bulletin no. 181: prevention of Rh D alloimmunization
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