Resumo
Definição
História e exame físico
Key diagnostic factors
- presença de fatores de risco
Risk factors
- história de feto Rhesus (Rh) D positivo em mãe RhD negativa
- hemorragia feto-materna
- procedimentos fetais invasivos
- trauma placentário
- aborto
- multiparidade
- omissão da imunoprofilaxia para rhesus D (RhD)
- versão cefálica externa
- gravidez molar
- gravidez ectópica
Diagnostic tests
1st tests to order
- tipo sanguíneo materno
- exame de anticorpos 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 doença hemolítica do neonato
Contributors
Authors
Andrea Shields, MD
Associate Professor of Obstetrics and Gynecology
Program Director Maternal Fetal Medicine Fellowship
Division of Maternal Fetal Medicine
University of Connecticut School of Medicine
Farmington, CT
Disclosures
AS declares that she has no competing interests.
Kristen Elmezzi, DO
Maternal Fetal Medicine Fellow
Division of Maternal Fetal Medicine
University of Connecticut School of Medicine
Farmington, CT
Disclosures
KE declares that she has no competing interests.
Acknowledgements
Dr Andrea D. Shields and Dr Kristen Elmezzi would like to gratefully acknowledge Dr Andrew D. Hull, 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. ADH, 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
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
Brennand J, Cameron A. Fetal anaemia: diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2008 Feb;22(1):15-29. 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
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
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
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- Guideline for the investigation and management of red cell antibodies in pregnancy
More Guidelines
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