ISOIMMUNIZATION

Definition - Is a possibility when a woman who is Rh negative is sensitized and carrying a fetus who is rh positive. Etiology, causes, risk factors It rarely occurs in a woman's first pregnancy. She only becomes sensitized to the fetus's Rh-positive blood once she comes in contact with it. Risk factors: Being a pregnant woman with Rh-negative blood who had a prior pregnancy with a fetus that was Rh positive Being a pregnant woman who had a prior blood transfusion or amniocentesis Being a pregnant woman with Rh-negative blood who did not receive Rh immunization prophylaxis during a prior pregnancy with an Rh-positive fetus

ASSESSMENT o Rh incompatibility occurs when a woman is Rh negative, but her fetus has inherited Rh-positive blood from the father. This can also occur during a miscarriage , induced abortion , or ectopic pregnancy .

It is asymptomatic for mothers but possible complications can lead to hemolytic disease in the neonate. Increased concentration (optical density) of bilirubin and RBC breakdown products in the amniotic fluid. Has an anti-D antibody titer of 1:16 or greater, showing Rh sensitization, the fetus will be monitored every 2 weeks (or more often) to detect presence of anemia.

 PATHOPHYSIOLOGY - A female may also become sensitized from receiving blood transfusions with alien Rh antigens, causing agglutinins to develop. - Subsequent pregnancy with an Rh-positive fetus triggers increasing amounts of maternal agglutinating antibodies to cross the placental barrier, attach to Rh-positive cells in the fetus, and cause hemolysis and anemia to the neonate. - To compensate for this, the fetus steps up the production of RBCs, and erythroblasts (Immature RBCs) appear in the fetal circulation.

 INTERVENTIONS/MANAGEMENTS - Possible early delivery of the fetus Nursing treatment - Nurse maintains documentation of blood volumes exchanged, including the amount of blood withdrawn and infused. - Vital signs monitored. - Nurse encourages the parents to express their thoughts. - Nurse should praise parents for actions they took to prevent any problem, such as frequent antepartum examinations and blood tests. Medical treatment
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rhIg or RhoGAM this prevents the mothers antibodies from being able to react to Rh positive cells Intrauterine transfusion o Beforehand, obtain a baseline FHR through electronic monitoring and explain to the patient the procedure and its purpose. o Afterward, carefully observe the patient for uterine contractions and fluid leakage from the puncture site. o Monitor FHR for tachycardia or bradycardia.

amniocentesis or chorionic villi sampling

Ultrasonography Screening for bloodtype of the pregnant mother. Indirect Coombs test