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Incompatibilidad Rh

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 11 Sep 2025
Last updated: 11 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
Full details

Risk factors

  • antecedentes de un feto RhD positivo en una madre RhD negativa
  • hemorragia fetomaterna
  • procedimientos fetales invasivos
  • traumatismo placentario
  • aborto
  • multiparidad
  • omisión de la inmunoprofilaxis Rh
  • versión cefálica externa
  • embarazo molar
  • embarazo ectópico
Full details

Diagnostic investigations

1st investigations to order

  • grupo sanguíneo materno
  • cribado de anticuerpos Rh séricos maternos
Full details

Investigations to consider

  • título de anticuerpos séricos maternos
  • grupo sanguíneo paterno
  • cigosis paterna
  • ultrasonido fetal
  • Velocimetría Doppler de la arteria cerebral media fetal (velocidad sistólica pico)
  • determinación del grupo sanguíneo fetal (por amniocentesis o circulación maternal)
  • evaluación directa de la anemia fetal
  • prueba de rosetas
  • prueba de Kleihauer-Betke/citometría de flujo
Full details

Treatment algorithm

INITIAL

madre RhD negativa no sensibilizada

madre RhD negativa sensibilizada

ACUTE

neonato con eritroblastosis

Contributors

Authors

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

Disclosures

ADH declares that he has no competing interests.

Acknowledgements

Dr Andrew D. Hull would like to gratefully acknowledge Dr Karen Fung-Kee-Fung and Dr Felipe Moretti, previous contributors to this topic.

Disclosures

KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have 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 topic.

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.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008 Feb;22(1):15-29. Abstract

American College of Obstetrics and Gynecology. ACOG practice bulletin no. 181: prevention of Rh D alloimmunization. Obstet Gynecol. 2017 Aug;130(2):e57-70. Abstract

American Congress of Obstetrics and Gynecology. ACOG practice bulletin no. 192: management of alloimmunization during pregnancy. Obstet Gynecol. 2018 Mar;131(3):e82-90. Abstract

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.Full text  Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Incompatibilidad Rh images

  • Differentials

    • Hidropesía fetal no inmune
    • Infección por parvovirus
    • Enfermedad hemolítica no RhD
    More Differentials

  • Guidelines

    • 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
    More Guidelines
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