RH INCOMPATIBILITY AND PREGNANCY
CARE OF MOTHER, CHILD – AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)
BSN 2022-2023|Sophomore 2nd Sem, Prelim
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RH INCOMPATIBILITY
• The Rh blood antigen, or Rh factor, is present on the
surface of erythrocytes of a majority of the population
• Rh factors are genetically determined
• Rh factors follow a common pattern of genetic
inheritance
• The Rh-positive gene is dominant (stronger) & even
when paired with a Rh-negative gene, the positive
gene takes over
• A baby receives one gene from
o If a person has the genes + +, the Rh factor in the
blood will be positive.
o If a person has the genes + -, the Rh factor will be
positive.
o If a person has the genes - -, the Rh factor will be
negative.
• Rh alloimmunization (sensitization) occurs when:
- An Rh-negative woman carries and Rh-positive
fetus
- An Rh-negative nonpregnant woman receives an
Rh-positive BT
• The RBCs from the fetus invade the maternal
circulation → production of Rh antibodies
• First offspring is not affected
• In a subsequent pregnancy: Rh antibodies cross the
placenta & enter the fetal circulation → severe
hemolysis
• Rhesus (Rh) factor incompatibility during pregnancy
is possible only when two specific circumstances
coexist:
- expectant mother is Rh (-)
- fetus is Rh (+)
• Small placental accidents may occur that allow a drop
or two of fetal blood to enter the maternal circulation.
• Sensitization may also occur in other cases such as
elective or spontaneous abortions or even during
antepartal procedures
• A rapid immune response against Rh (+) blood occurs
with extensive fetal-maternal hemorrhage
• Remember: Rh incompatibility is a problem that
affects the fetus; it causes no harm to the expectant
mother
FETAL-NEONATAL RISKS
• Congestive heart failure
• Hydrops fetalis
• Icterus gravis
• Kernicterus
• Erythroblastosis Fetalis
NURSING CARE OF THE PREGNANT WOMAN
WITH RH INCOMPATIBILITY
ASSESSMENT
• AT THE FIRST PRENATAL VISIT, CAREGIVERS:
1. Take a history of previous:
o sensitization
o abortions
o blood transfusions
o children who developed jaundice or anemia
during the newborn period
2. determine maternal blood type (ABO) & Rh factor
& do a routine Rh antibody screening test
3. identify other medical complications such as
diabetes, infections or hypertension
• Antibody screesning test
- determines whether there are antibodies to the
Rh factor in the mother’s blood
- normal (negative) result =mother has not
developed antibodies against the fetus blood
- abnormal (positive) result = mother has
developed antibodies to the fetal RBCs & is
sensitized
• Antibody titer of greater than 1:4 (POSITIVE)
- This tells how many times there is a need to dilute
the blood to get rid of the antibodies. The higher
the second number, the more likely baby is to be
affected.
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NURSING DIAGNOSIS IMPLEMENTATION
• Health-seeking behaviors: Information about Rh EDUCATIVE
immune globulin related to an expressed need to • Explain the purpose of the Rh immune globulin
understand the implications of being Rh negative & administered at 28 weeks’ gestation if the woman is
pregnant. not sensitized
• Ineffective individual coping related to depression • Note that Rh immune globulin provides passive
secondary to the development of indications of the immunity
need for fetal exchange transfusion. • Rh immune globulin is not given to the newborn or the
PLANNING father.
• The woman will explain the process of Rh • Woman explains the process of Rh sensitization & its
sensitization & its implications for her unborn child & implications for her unborn child & for subsequent
for subsequent pregnancies. pregnancies.
• If the woman has not been sensitized, she will be able • Woman discusses the importance of receiving Rh
to discuss the importance of receiving Rh immune immune globulin when necessary & cooperates with
globulin when necessary & cooperates with the the recommended dosage schedule.
recommended dosage schedule. • Woman gives birth to a healthy newborn.
• The woman will be able to give birth to a healthy
newborn.
IMPLEMENTATION
ANTEPARTAL MANAGEMENT
• If the antibody screen obtained at 28 weeks’ gestation
is negative, woman is given 300 mcg of Rh immune
globulin (RhoGAM) IM as a prophylactic (preventive)
measure.
• If woman is Rh (-) (not sensitized) & the father is Rh
(+) or unknown:
- Rh immune globulin is also given after each
abortion, ectopic pregnancy, or amniocentesis
• If abortion or ectopic pregnancy occurs in the first
trimester, a smaller (50 mcg) dose of Rh immune
globulin (MICRhoGAM or Mini-Gamulin Rh) is used.
• A full dose is used following second trimester
amniocentesis.
• Two primary interventions can help the fetus whose
blood cells are being destroyed by maternal
antibodies:
- Early birth
- Intrauterine transfusion
• Ultrasound should be done at 14 to 16 weeks to
determine gestational age, severe fetal involvement,
increase in fetal heart size & hydramios.
• Measure peak systolic middle cerebral artery (MCA)
velocity in fetus
- non-invasive clinical test for the prediction of fetal
anemia
• Percutaneous Umbilical Blood Sampling (PUBS)
is performed to determine fetal hematocrit
• Severely sensitized fetuses may require birth at 32-
34wks
POSTPARTAL MANAGEMENT
• The Rh-negative mother who has no antibody titer
(indirect Coombs’ test negative, nonsensitized) & has
given birth to an Rh-positive fetus (direct Coombs’
test negative) is given an IM injection of Rh immune
globulin (RhoGAM) within 72 hours of childbirth.

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