Rh incompatibility
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presence of risk factors
Fatores de risco
- history of an RhD-positive fetus in an RhD-negative mother
- fetomaternal hemorrhage
- invasive fetal procedures
- placental trauma
- abortion
- multiparity
- omission of Rh immunoprophylaxis
- external cephalic version
- molar pregnancy
- ectopic pregnancy
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- maternal blood type
- maternal serum Rh antibody screen
Investigações a serem consideradas
- maternal serum antibody titer
- 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 anemia
- rosette test
- Kleihauer-Betke test/flow cytometry
Algoritmo de tratamento
unsensitized RhD-negative mother
sensitized RhD-negative mother
neonate with erythroblastosis
Colaboradores
Autores
Andrew D. Hull, MD, FRCOG, FACOG
Professor of Clinical Obstetrics, Gynecology, and Reproductive Sciences
Director, UC San Diego Maternal-Fetal Care and Genetics
Division of Maternal-Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of California San Diego
La Jolla
CA
Declarações
ADH declares that he has no competing interests.
Agradecimentos
Dr Andrew D. Hull would like to gratefully acknowledge Dr Karen Fung-Kee-Fung and Dr Felipe Moretti, previous contributors to this topic.
Declarações
KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have no competing interests.
Revisores
Alan Cameron, MD
Honorary Professor of Medicine
University of Glasgow
Glasgow
UK
Declarações
AC is an author of several references cited in this topic.
Liakat Ali Parapia, MD, FRCP
Consultant Hematologist
Bradford Teaching Hospitals NHS Trust
Yorkshire Clinic
Bingley
Bradford
UK
Declarações
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
利益声明
KJM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008 Feb;22(1):15-29. 摘要
American College of Obstetrics and Gynecology. ACOG practice bulletin no. 181: prevention of Rh D alloimmunization. Obstet Gynecol. 2017 Aug;130(2):e57-70. 摘要
American Congress of Obstetrics and Gynecology. ACOG practice bulletin no. 192: management of alloimmunization during pregnancy. Obstet Gynecol. 2018 Mar;131(3):e82-90. 摘要
Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20.全文 摘要
Visser GHA, Thommesen T, Di Renzo GC, et al. FIGO/ICM guidelines for preventing Rhesus disease: a call to action. Int J Gynaecol Obstet. 2021 Feb;152(2):144-7.全文 摘要
Whyte RK, Jefferies AL; Canadian Paediatric Society, Fetus and Newborn Committee. Red blood cell transfusion in newborn infants. Paediatr Child Health. 2014 Apr;19(4):213-22.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Nonimmune fetal hydrops
- Parvovirus infection
- Non-RhD hemolytic disease
更多 鉴别诊断指南
- ACOG clinical practice update: paternal and fetal genotyping in the management of alloimmunization in pregnancy
- ACOG clinical practice update: Rh D immune globulin administration after abortion of pregnancy loss at less than 12 weeks of gestation
更多 指南
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