src/processed_markdown/RhESUS/RhESUS.md

---\n\ncitation: "RhESUS"\n\n---\n\nManagement Rhesus Negative Mother

Routine blood test Identification of Rh-negative mother Check unexpected antibody levels at booking visit, 28,32 and 36 weeks of POA A titre of >1:4 Non-sensitized mother o No potentially sensitizing events o Threatened miscarriage before 12 weeks Already sensitized Initial procedure is determined by past clinical history. Usually performed at least 4-8 weeks earlier than the previous point of Significant morbidity due to Early pregnancy previous complications event o Suspected termination Before 20 weeks Anti- D Ig-250 IU ROUTINE CARE Anti-D Ig-500 IU 28weeks o Ectopic pregnancy o Spontaneous miscarriage o Threatened miscarriage- After 12 weeks After 20 weeks Anti- D Ig-500 IU TEST FOR FMH Potentially sensitizing events o Antepartum Haemorrhage o External cephalic version o Closed abdominal Anti-D Ig- 500 IU Anti-D Ig-500 IU 32weeks >4ml Red cells injury o Intrauterine death o Invasive perinatal Additional anti-D Ig The dose to be diagnosis administered should assume that 500iu of anti-D Ig IV will suppress immunization by 8-10 ml of fetal RBC Post Partum management Gynaecology Mother Cord blood for, o 2ml (Plain bottle)-Grouping & Rh. o 2ml (EDTA bottle)-Fetal Hb. o 2ml (Plain bottle)-Serum bilirubin o 2ml (Plain bottle)-Direct Coomb’s test. o 2ml (EDTA bottle)-Reticulocyte count FMH test in (Kleihauer acid elution test), Traumatic delivery-LSCS Manual removal of placenta. Stillbirth/IUD. Abdominal trauma in 3rd trimester. Twin pregnancy (At delivery) Unexplained Hydrops Fetalis First sensitized Sensitized mother pregnancy. (Previously affected pregnancy) Initial procedure is determined by past clinical Check partners blood history. Usually performed at least 4-8 weeks earlier than the previous Rh positive Rh negative point of Significant morbidity No Further Investigations IAT titer ≤1:32 IAT titer Check >1:32/ partner’s blood Albumin titer >1:16 IAT titer ≥1:64 Repeat Amniocent antibody esis every titers every 2-3 weeks 2-4 weeks FMH-Feto-Maternal Transfusion IAT-Indirect Antibody Test Anti-D Ig recommended because of No risk silent FMH At risk Investigation D o c u m e n a t t i o n M a n d a t o r y

1ST

TRIMESTER

20 WEEKS

24 WEEKS

2ND

TRIMESTER

TRIMESTER

28WEEKS

3RD

TRIMESTER

LABOUR

POST

PARTUM

Sri Lanka College of Obstetrics and

Health sector development Project

Guidelines- Management Rhesus Negative