SISTER NIVEDITA GOVERNMENT NURSING

COLLEGE

IGMC, SHIMLA

PRESENTATION ON

ABO & Rh incompatibility

SUBMITTED TO: SUBMITTED BY:

Dr. Sarita Thakur Radhika Sharma

Associate Professor cum Registrar M.Sc. 2ND Year

Obstetric and Gynecological Nursing Obstetric and Gynecological Nursing

SNGNC, IGMC, Shimla SNGNC, IGMC, Shimla

SUBMITTED ON-
 INDEX

SR. NO. CONTENT REMARKS

1. INTRODUCTION

2. WHY IS IT IMPORTANT?

3. HISTORY

4. DEFINITION OF RH
INCOMPATIBILITY

5. INCIDENCE

6. CAUSES

7. PATHOPHYSIOLOGY OF RH
INCOMPATIBILITY

8. CLINICAL MANIFESTATIONS
OF RH INCOMPATIBILITY

9. DIAGNOSTIC EVALUATION

10. MANAGEMENT OF RH
INCOMPATIBILITY

11. NURSING ROLE

12. RESEARCH ARTICLE

13. CONCLUSION

14. BIBLIOGRAPHY
INTRODUCTION

What is Rhesus

The Rhesus (Rh) factor is a type of protein found on the surface of red blood cells. It's inherited
from your parents. If you have the protein, you're Rh-positive. If you don't have the protein,
you're Rh-negative.

WHY IS IT IMPORTANT?

Blood Transfusions: It's crucial to match Rh factors when receiving blood transfusions. Giving
the wrong type can lead to serious complications.

Pregnancy: If a Rh-negative mother carries a Rh-positive fetus, her body may produce antibodies
against the baby's red blood cells. This can cause problems for the baby, especially in subsequent
pregnancies.

To prevent this, Rh-negative mothers are often given RhoGAM(immunoglobin) during

pregnancy to prevent the development of these antibodies.

HISTORY

 The Rhesus factor gets its name from experiments conducted in 1937 by scientists Karl
Landsteiner and Alexander S. Weiner.

 Their experiments involved rabbits which, when injected with the Rhesus monkey's red
blood cells, produced an antigen that is present in the red blood cells of many humans.

 Rh antigen also present in the rhesus monkeys.

 5 Major Rh antigen C, c, E, e, D

 Rh D antigen a protein immunogenic.

DEFINITION OF RH INCOMPATIBILITY.
Rh incompatibility is a condition that arises when a pregnant woman who is Rh-negative carries
a Rh-positive fetus. It occurs due to the incompatibility between the mother's Rh-negative blood
and the fetus's Rh-positive blood, and thus antibodies is produced by mother during the birth of
first child which remains inside mother after the first pregnancy which can affect second
pregnancy that leads to Rh incompatibility.

INCIDENCE

The incidence of Rh incompatibility is relatively low, occurring in about 16% of pregnancies

where the mother is Rh-negative. However, with the widespread use of Rh immune globulin
(RhoGAM) during pregnancy, the incidence of severe Rh incompatibility has significantly
decreased.

CAUSES

Rh incompatibility is primarily caused by the following:

Placental exchange: During pregnancy, there is a small exchange of blood between the mother
and the fetus through the placenta. If the mother's blood comes into contact with the Rh-positive
fetal blood, her immune system may start producing antibodies against the Rh factor.

Previous Rh-positive pregnancies or miscarriages: As mentioned earlier, previous

pregnancies or miscarriages can sensitize the mother's immune system to the Rh factor,
increasing the risk of antibody production in subsequent pregnancies.

PATHOPHYSIOLOGY OF RH INCOMPATIBILITY
Initial Sensitization: When a Rh-negative mother is first exposed to Rh-positive fetal RBCs
(usually during childbirth, miscarriage, or trauma), her immune system may recognize these Rh-
positive cells as foreign and develop antibodies against the Rh antigen. This is called
"sensitization."
IgG Antibody Production: The mother's immune system produces IgG antibodies against the
Rh antigen. These antibodies can cross the placenta in subsequent pregnancies.
Fetal Red Blood Cell Hemolysis: In a subsequent pregnancy with an Rh-positive fetus, the
maternal IgG antibodies cross the placenta and attack the fetus's Rh-positive RBCs. This immune
reaction causes hemolysis (breakdown of RBCs) in the fetus.

CLINICAL MANIFESTATIONS OF RH INCOMPATIBILITY

In Mild Cases:
Jaundice: Typically occurs within 24 hours after birth due to elevated bilirubin levels from red
blood cell breakdown.

Anemia: Mild to moderate anemia as fetal red blood cells are destroyed by maternal antibodies.

Hepatosplenomegaly: Enlargement of the liver and spleen due to increased blood cell
destruction and compensatory blood production.

In Severe Cases:

Severe Jaundice (Kernicterus): Excessive bilirubin can deposit in the brain, leading to
neurological damage if untreated.

Severe Anemia: Profound anemia can cause tissue hypoxia, tachycardia, and poor growth.

Hydrops Fetalis: A life-threatening condition marked by extreme fluid accumulation (edema) in

fetal tissues, ascites, pleural effusion, and pericardial effusion.

Heart Failure: Resulting from severe anemia and hydrops fetalis, which increase the heart's
workload.

Stillbirth: In very severe cases, where the fetus cannot survive the effects of Rh incompatibility.

Post-Birth Manifestations

Lethargy and Poor Feeding: Affected infants may have decreased energy and feeding difficulty
due to jaundice or anemia.

Pallor or Cyanosis: Due to anemia and poor oxygenation.

Neurological Symptoms: In severe jaundice cases, symptoms can include hypotonia, high-
pitched crying, and poor reflexes.

DIAGNOSTIC EVALUATION

If Rh incompatibility is diagnosed during pregnancy, the following additional management

strategies may be considered:

Obstetrical history-

 In a parous woman, a detailed obstetric history has to be taken.

 History of prophylactic administration of anti-D immunoglobulin following abortion or
delivery.

Anti globulin test (AGT) Two coomb’s test are:

i) Direct coomb’s test (DCT)

ii) Indirect coomb’s test (ICT)

1. DIRECT COOMB’s TEST -To detect the antibodies or complement protein that are bound
to the surface of RBCs.

2. INDIRECT COOMB’s TEST- It detect antibodies against RBCs that are present unbound in
the patient’s serum.

Antibody detection - Detected by indirect coomb’s test - If test negative at 12th week, it
repeated at 28th week and 36th week in primi gravida. - If positive then screening of patient. -
Quantitative estimation of IgG antibody at weekly intervals.  Doppler ultrasound - A value > 1.5
multiples of the median (MOMs) for the corresponding gestational age, predicts moderate to
severe fetal anemia.

Frequent ultrasounds: Ultrasounds can be used to monitor the growth and development of the
fetus.

Amniocentesis: Amniocentesis can be performed to assess the severity of the anemia and
determine the need for further interventions.

Intrauterine blood transfusion: In severe cases, intrauterine blood transfusions may be

performed to replace the damaged red blood cells.

Early delivery: In some cases, early delivery may be recommended to prevent further
complications.

A bilirubin test may be performed on pregnant women who are Rh-negative to check for an
abnormal breakdown of red blood cells in the baby.

Management of Rh incompatibility

There are two main ways to manage Rh incompatibility:

Prevention: The best way to prevent Rh incompatibility is to give Rh-negative mothers an
injection of Rh immune globulin (RhoGAM) during pregnancy. RhoGAM is a medication that
prevents the mother's body from producing antibodies against the baby's red blood cells.
RhoGAM is usually given at 28 weeks of pregnancy and again within 72 hours after delivery.

Treatment: If the baby is already affected by Rh incompatibility, treatment will depend on the
severity of the condition. Mild cases of Rh incompatibility may be treated with phototherapy,
which uses special lights to break down bilirubin, a yellow substance in the blood. Severe cases
of Rh incompatibility may require an exchange transfusion, which is a procedure to replace the
baby's blood with donor blood.

2. Monitoring During Pregnancy

Get regular prenatal care: This is important for monitoring the baby's health and for receiving
timely treatment if needed.

Know your blood type: If you are Rh-negative, it is important to know your blood type so that
you can take steps to prevent Rh incompatibility.

Talk to your doctor about RhoGAM: If you are Rh-negative, you should talk to your doctor
about receiving RhoGAM during pregnancy. Rh Incompatibility: Symptoms, Diagnosis &
Treatments - Healthline

Antenatal testing: Pregnant women with Rh incompatibility undergo regular blood tests to
monitor for any antibodies against Rh-positive cells. If antibodies are detected, the fetus may be
monitored for signs of anemia or other complications.

Ultrasound and Doppler studies: If there is evidence of sensitization, an ultrasound and

Doppler studies of the middle cerebral artery (MCA) may be used to check for fetal anemia.

3. Treatment of Affected Fetus or Newborn

Intrauterine transfusions: If the fetus shows severe anemia, intrauterine blood transfusions
may be given directly to the fetus to replace destroyed red blood cells.

Early delivery: In severe cases, if the fetus is mature enough, early delivery may be
recommended to manage the newborn's condition outside the womb.
Phototherapy for newborns: After birth, if the newborn has jaundice, phototherapy may be
used to reduce bilirubin levels.

Exchange transfusion for newborns: In severe cases of jaundice or anemia in the newborn, an
exchange transfusion may be needed to replace the baby's Rh-positive blood with Rh-negative
blood, reducing antibody levels and bilirubin.

4. Follow-up

Monitoring bilirubin levels: After birth, close monitoring of the newborn’s bilirubin levels is
essential to prevent complications.

Long-term monitoring: Some babies affected by severe Rh incompatibility may need long-term
follow-up if they experienced significant anemia or hyperbilirubinemia.

With timely administration of RhIg and careful monitoring, most cases of Rh incompatibility can
be managed successfully, minimizing risks to both the mother and baby.

NURSING ROLE

A nurse's responsibilities in relation to Rh incompatibility include:

Educating parents: Informing the parents about the risks of Rh incompatibility and how to
prevent it.

Monitoring: Monitoring the mother and newborn for signs of hemolytic disease

Administering RhoGAM: Giving the mother an injection of RhoGAM, an immune globulin, to

prevent the development of antibodies against the baby's red blood cells

Providing care: Helping the mother and father care for the baby after birth, and advising the
mother on limiting physical activity

Screening: Performing prenatal screenings to detect Rh incompatibility.

RESEARCH ARTICLE

Aya Salah Abd Elhakim, Nabila Taha Ahmad, Walaa Hamza Ibrahim (2024), To Assess the
knowledge regarding Rhesus Incompatibility among Pregnant Women’s in Health HospitalAssiut
University, Egypt. A convenient sample technique was used to select the 300 pregnant women.
Data was collected by structured interview questionnaire. The result revealed that only 19.7% of
the studied women had good knowledge while 58.7% had poor knowledge regarding rhesus
factor and Rh incompatibility. The conclusion of the study was more than half of the studied
pregnant women had poor knowledge regarding Rh factor and Rh incompatibility.
Recommendations: provide health education supported by drawing pamphlets and brochure
about Rh factor and Rh incompatibility for pregnant women. Implementing Rhesus compatibility
screening program for intending couples and first-time mothers.
CONCLUSION

Rh incompatibility occurs when a pregnant woman has Rh-negative blood and her fetus has Rh-
positive blood. This can lead to the mother's immune system attacking the fetus's red blood cells,
causing hemolytic anemia. However, this condition can be prevented with timely administration
of Rh immune globulin during pregnancy.

BIBLIOGRAPHY

 D.C. dutta, “ A textbook of obstetrics“, 8th edition, 2015, Jaypee brothers Medical
publishers (p) ltd, p.p 386-388.

 Jacob, A. “Manual of midwifery and gynecological nursing, first edition, 2009, New Delhi ,
Japee brother Medical publication (p)ltd. P.447.

 Kamini R, “Textbook of midwifery obstetrics for nurses” 2011, ELSEVIER, p.p. 243-244.

NET REFERECE

https://www.slideshare.net/slideshow/6-rh-amp-abo-incompatibility-238334161/238334161#6