Rh incompatibility occurs when a woman with Rh-negative blood is pregnant with a baby who has Rh-positive blood. If her blood mixes with the baby's blood, she can develop antibodies that may affect future pregnancies. It is treated by giving the mother Rh immunoglobulin during and after pregnancy to prevent antibody formation. For affected babies, treatment depends on severity but may include phototherapy or exchange transfusion for severe cases of hemolytic anemia. Regular prenatal screening and prompt treatment with Rh immunoglobulin can prevent Rh incompatibility in subsequent pregnancies.

1. RH INCOMPATIBILITY
SWATILEKHA DAS
(RN,MSN)

2. INTRODUCTION
Rh incompatibility is a condition that
occurs during pregnancy if a woman
has Rh-negative blood and her baby
has Rh-positive blood.

3. DEFINITION
Rh disease (also known as rhesus
isoimmunisation, Rh (D) disease, rhesus
incompatibility, rhesus disease, RhD hemolytic
disease of the newborn, rhesus D hemolytic
disease of the newborn or RhD HDN) is a type
of hemolytic disease of the newborn (HDN).
The disease ranges from mild to severe, and
typically occurs only in some second or
subsequent pregnancies of Rh negative women
where the fetus's father is Rh positive, leading to
a Rh+ pregnancy.

4. CAUSES
A difference in blood type between a
pregnant woman and her baby causes
Rh incompatibility. The condition occurs
if a woman is Rh-negative and her baby
is Rh-positive.

5. RISK FACTORS
This may have happened during:
 An earlier pregnancy (usually during delivery).
 An ectopic pregnancy, a miscarriage, or an
induced abortion. (An ectopic pregnancy is a
pregnancy that starts outside of the uterus, or
womb.)
 A mismatched blood transfusion or blood and
marrow stem cell transplant.
 An injection or puncture with a needle or other
object containing Rh-positive blood.

6. PATHOPHYSIOLOGY
Rh Incompatibility in Pregnancy-
1st Pregnancy
Father (RhD+)
Mother (RhD-)
Fetus (RhD+)
first newborn(RhD+)Safe
But mother (RhD-) is now
sensitized to RhD antigen.Fetal –maternal blood
transfer during labor

7. 2nd Pregnancy-
Rapid production of IgG
anti-D by mother
Maternal IgG anti-D
crosses placenta.
IgG anti-D attaches to
fetal BBCs & marks them
for destruction.
Fetal or newborn Hemolytic
Anemia.
Mild case
Mild anemia,
jaundice
Severe
Incresed billirubin.
CNS
damage(kernicterus),
death.
Father (RhD+)
Mother (RhD-)
Fetus (RhD+)
Repeat encounter with
fetal RhD antigen
Note: If mother is sensitized to RhD antigen prior to first pregnancy, then first fetus will
be affected.

9. SIGNS & SYMPTOMS OF RH
INCOMPATIBILITY
It can cause symptoms ranging from very mild to
fatal.
Mildest form – Rh Incompatibility:
1. Hemolysis
2. Jaundice
3. Total body swelling
4. Respiratory distress
5. Circulatory collapse
6. Kernicterus
7. It occurs several days after delivery and is
characterized initially by-
A. Poor feeding
B. Decreased activity

10. DIAGNOSTIC TESTS
MATERNAL BLOOD-
 The Kleihauer-betke test or flow
cytometry
 Indirect coombs test
FETAL BLOOD-
• The direct Coombs test
• Blood count
• Billirubin(direct & indirect)

11. TREATMENT
Rh incompatibility is treated with a medicine called Rh immunoglobulin.
Treatment for a baby who has hemolytic anemia will vary based on the
severity of the condition.
Goals of Treatment
 The goals of treating Rh incompatibility are to ensure that baby is healthy
and to lower mother’s risk for the condition in future pregnancies.
Treatment for Rh Incompatibility
 If Rh incompatibility is diagnosed during pregnancy, mother will receive Rh
immunoglobulin in seventh month of pregnancy and again within 72 hours
of delivery.
 Mother also may receive Rh immunoglobulin if the risk of blood transfer
between mother and the baby is high (for example, a miscarriage, ectopic
pregnancy, or bleeding during pregnancy).

12.  Rh immunoglobulin contains Rh antibodies that attach to
the Rh-positive blood cells in mother’s blood. When this
happens, mother’s body doesn't react to the baby's Rh-
positive cells as a foreign substance. As a result, mother’s
body doesn't make Rh antibodies. Rh immunoglobulin
must be given at the correct times to work properly.
 Once mother have formed Rh antibodies, the medicine will
no longer help. That's why a woman who has Rh-negative
blood must be treated with the medicine with each
pregnancy or any other event that allows her blood to mix
with Rh-positive blood.
 Rh immunoglobulin is injected into the muscle of arm or
buttock. Side effects may include soreness at the injection
site and a slight fever. The medicine also may be injected
into a vein.

13. SCREENING & PREVENTION
 Rh incompatibility can be prevented with Rh immunoglobulin,
as long as the medicine is given at the correct times. Once
mother has formed Rh antibodies, the medicine will no longer
help.
 Thus, a woman who has Rh-negative blood must be treated
with Rh immunoglobulin during and after each pregnancy or
after any other event that allows her blood to mix with Rh-
positive blood.
 Early prenatal care also can help prevent some of the
problems linked to Rh incompatibility. For example, doctor
can find out early whether mother is at risk for the condition.
 If mother is at risk, doctor can closely monitor pregnancy. He
or she will watch for signs of hemolytic anemia in baby and
provided treatment as needed.

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