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Incompatibilidade de Rh

Última revisão: 12 Aug 2025
Última atualização: 11 Apr 2025

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
Detalhes completos

Fatores de risco

  • história de feto RhD-positivo em mãe RhD negativa
  • hemorragia feto-materna
  • procedimentos fetais invasivos
  • trauma placentário
  • aborto
  • multiparidade
  • omissão da imunoprofilaxia de Rh
  • versão cefálica externa
  • gravidez molar
  • gravidez ectópica
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • tipo sanguíneo materno
  • exame de anticorpos Rh no soro materno
Detalhes completos

Investigações a serem consideradas

  • título de anticorpos séricos materno
  • tipo sanguíneo paterno
  • zigosidade paterna
  • ultrassonografia fetal
  • velocimetria Doppler da artéria cerebral média do feto (pico de velocidade sistólica)
  • tipagem sanguínea do feto (decorrente de amniocentese ou circulação materna)
  • avaliação direta de anemia fetal
  • teste de roseta
  • teste de Kleihauer-Betke/citometria de fluxo
Detalhes completos

Algoritmo de tratamento

Inicial

mãe RhD-negativa não sensibilizada

mãe RhD-negativa sensibilizada

AGUDA

neonato com eritroblastose

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

Divulgaciones

ADH declares that he has no competing interests.

Agradecimientos

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

Divulgaciones

KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have no competing interests.

Revisores por pares

Alan Cameron, MD

Honorary Professor of Medicine

University of Glasgow

Glasgow

UK

Divulgaciones

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

Divulgaciones

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

Divulgaciones

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.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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

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

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

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.Texto completo  Resumen

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.Texto completo  Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
  • Incompatibilidade de Rh images
  • Diferenciales

    • Hidropisia fetal não imune
    • Infecção por parvovírus
    • Doença hemolítica não relacionada ao RhD
    Más Diferenciales
  • Guías de práctica clínica

    • 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
    Más Guías de práctica clínica
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