Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
Risk factors
- 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
Diagnostic tests
1st tests to order
- tipo sanguíneo materno
- exame de anticorpos Rh no soro materno
Tests to consider
- 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
Treatment algorithm
mãe RhD-negativa não sensibilizada
mãe RhD-negativa sensibilizada
neonato com eritroblastose
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
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.
Differentials
- Hidropisia fetal não imune
- Infecção por parvovírus
- Doença hemolítica não relacionada ao RhD
More DifferentialsGuidelines
- 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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