Rh Isoimmunization - Update
Rh isoimmunization continues to occur because some susceptible women are not identified and are not given Rh immunoglobin (Rh1G) prophylaxis, or because routine postpartum prophylaxis fails due to an unrecognized excessive fetomaternal hemorrhage. Methods of identifying fetomaternal hemorrhage are discussed. Administration of Rh/G after early pregnancy losses, after amniocentesis, after other selected obstetric events, and to all Rh-negative, unsensitized women at 28 to 29 weeks of gestation will minimize isoimmunization during pregnancy. The protocol for identifying new or developing cases of isoimmunization, and for treating identified patients is presented. Women whose fetuses are severely affected should be referred to perinatal centers for specialized care. This care includes repeated ultrasound examinations, amniocentesis, and may also involve intrauterine transfusions, plasmapheresis, and preterm delivery.
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