R h negative pregnancy

 Rh antigen: c C D E e
 If D is present then pregnancy is Rh positive.
 If D is absent then pregnancy is Rh negative.

 Located on short arm of chromosome 1

 Discovered by Landsteiner and Werner

 Rh negative pregnancy means – that mother is Rh

negative but fetus is Rh positive. This is problem.

 How to know Rh status of fetus?

 First investigation should be done with Rh negative
pregnant female is ‘husbands Rh status’.

 Due to Rh incompatibility 1st child stay unaffected.

2nd child will develop problem.

 Fetus affected in Rh negative pregnancy

 Hemolysis in fetus
 Fetal anemia
 Sinusoidal heart rate pattern
 Peak systolic velocity increases in middle cerebral
artery
 Collection of fluid in 3rd space (pericardial effusion,
pleural effusion, ascites)

 Increase bilirubin
 Jaundice
 If bilirubin > 20 mg/dl  kernicterus
 Bilirubin excretes into urine  golden yellow
amniotic fluid

 Fetus will try to compensate for hemolysis

 So fetus will produce more RBC
 Leads to hepatospleenomegaly Erythroblastosis
 Bone marrow hyperplasia fetalis

 Due to hemolysis
 Fetus suffer hypoxia
 So placenta will supply more blood to fetus
 Leads to placentomegaly

 In the mother, due to placentomegaly, increased

chance of PIH.

 Fetal manifestation of Rh negative pregnancy:

 Fetal anemia
 Icterus gravidurum
 Hydrops fetalis

 Hydrops fetalis:
 Diagnosis: fluid in > 2 body cavities.
 Pleural effusion, pericardial effusion, ascitis, skin
edema.
 Skin edema – manifest in form of scalp edema – on
USG it is looks like halos around Buddha’s face – so
called Buddha sign.
 2 more feature seen but not part of diagnostic criteria:
 Polyhydraminos
 placentomegaly

 Hydrops fetalis: it can occur due to Rh negative

pregnancy or due to any other cause.

 It is due to Rh negative pregnancy – it is called

immune hydrops fetalis.

 Due to any other cause – non immune hydrops fetalis

NIHF.
 Other causes:
 Parvovirus infection
 Congenital heart blocks
 Alpha thallasemia
 GI problems
 Renal problems
 Chromosomal anomalies
 Cystic hygroma
 TTTS