Overview of Rhesus D alloimmunization in pregnancy

Background: The aim of this study is to review the latest issues and related topics for rhesus system, diagnosis and management of rhesus alloimmunization in pregnancy, in utero transfusion, and neonatal issues in detail separately.The absence of the D antigen (Rh negative blood type) occurs in 15% of whites, 7% of blacks, and less than 1% of the Native American and Asian populations.Maternal-fetal ABO incompatibility is somewhat protective against Rh isoimmunization. Prenatal profile ABO and Rh blood type and an antibody screen as part of the initial.pregnant woman has Rh-negative: If antibody screen negative: Repeat antibody screen at 28 weeks of gestation, and Obtain neonatal blood type after delivery.If anti-D antibody screen is positive: Maternal indirect Coombs test is needed to determine antibody titer.Determine paternal Rh status and zygosity, If father is heterozygous ,cell-free DNA (cfDNA)Testing is performed after 11 weeks of gestation.Prevention (HDFN):if the fetus is RHD-positive, the indirect Coombs titer is repeated monthly as long as stable if rising titers every two weeks.MCA-PSV measured weekly, beginning at 16 to 18 weeks gestation.When the critical titer(16 and 32 )is reached or exceeded , further assessment by MCA-PSV performed at one- to two-week intervals.An MCA-PSV ≤1.5 MoMs for gestational age , If MCA-PSV remains at this level, we schedule delivery at 37 to 38 weeks of gestation. An MCA-PSV > 1.5 MoMs for gestational age, obtain fetal hemoglobin by cordocentesis , if fetal hemoglobin is two standard deviations below the mean value for gestational age performing of intrauterine fetal transfusion recommended so as pregnancies <35 weeks of gestation after ≥35 weeks of gestation would deliver a fetus with MCA-PSV > 1.5 MoMs for gestational age.Conclusion:50 mcg of D immunoglobulin if pregnancy <13 weeks’ gestation and 300 mcg of D immunoglobulin for > 13 weeks’ gestation, is indicated.As antepartum prophylaxis at 28 weeks’ gestation, at 40 weeks’ gestation or at delivery if the neonate is D- or Du-positive. autism risk associated with,ABO or Rh incompatibility, and hyperbilirubinemia. the management of Rh-Rh incompatibility with noninvasive fetal Rh genotyping for targeted prophylaxis cost-effective.

کلیدواژه ها:

incompatibility ، D immunoglobulin ، gestational age