eMedicine Specialties > Emergency Medicine > Obstetrics & Gynecology

Rh Incompatibility: Follow-up

Author: Leon Salem, MD, MS, Associate Attending Physician, Kaiser Permanente, Southern California
Coauthor(s): Karen R Singer, PA-C, Department of Pediatrics, Fountain Valley Medical Center, South Counties Pediatric Critical Care Medical Group, Fountain Valley and Long Beach, California
Contributor Information and Disclosures

Updated: Nov 4, 2009

Follow-up

Further Inpatient Care

  • After administering Rh IgG in the ED, promptly refer the Rh-negative pregnant mother of an Rh-positive fetus to an institution equipped for high-risk obstetric care.

Deterrence/Prevention

  • Stress the importance of early prenatal care to each pregnant female who presents to the ED. Early administration of Rh IgG in conjunction with early prenatal care is the best means to prevent Rh incompatibility.

Complications

  • Emergent delivery of an infant with hydrops fetalis should be as nontraumatic as possible. Ideally, a neonatologist who is prepared to perform an exchange transfusion should attend to the infant immediately.4

Miscellaneous

Medicolegal Pitfalls

  • Potential reasons for postpartum clinical failures include the following:
    • Failure to type the patient's blood during the ED visit
    • Failure to administer Rh IgG when indicated
    • Error in typing the mother's or infant's blood
    • Unrecognized fetomaternal hemorrhage
    • Inadequate Rh IgG dosage for the volume of fetomaternal hemorrhage
 


More on Rh Incompatibility

Overview: Rh Incompatibility
Differential Diagnoses & Workup: Rh Incompatibility
Treatment & Medication: Rh Incompatibility
Follow-up: Rh Incompatibility
References
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References

  1. Thorp JM. Utilization of anti-RhD in the emergency department after blunt trauma. Obstet Gynecol Surv. Feb 2008;63(2):112-5. [Medline].

  2. [Guideline] US Preventive Services Task Force. Screening for Rh(D) incompatibility: recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). 2004;[Full Text].

  3. Herold TJ, Whittaker DS, Glynn T. Determining the accuracy of a rapid point-of-care test for determining Rh(D) phenotype. Acad Emerg Med. May 2005;12(5):474-6. [Medline].

  4. McMahan MJ, Donovan EF. The delivery room resuscitation of the hydropic neonate. Semin Perinatol. Dec 1995;19(6):474-82. [Medline].

  5. Agre P, Smith BL, Hartel-Schenk S. Biochemistry of the erythrocyte Rh polypeptides: a review. Yale J Biol Med. Sep-Oct 1990;63(5):461-7. [Medline].

  6. American College of Obstetricians and Gynecologists. Management of isoimmunization in pregnancy. ACOG Technical Bulletin 148; 1990.

  7. American College of Obstetricians and Gynecologists. Prevention of D isoimmunization. ACOG Technical Bulletin 147; 1990.

  8. Bowman JM. Hemolytic disease (erythroblastosis fetalis). In: Maternal-Fetal Medicine: Principles and Practice. 2nd ed. Philadelphia, Pa: WB Saunders; 1989:613-655.

  9. Copel JA, Gollin YG, Grannum PA. Alloimmune disorders and pregnancy. Semin Perinatol. Jun 1991;15(3):251-6. [Medline].

  10. Daffos F, Capella-Pavlovsky M, Forestier F. Fetal blood sampling via the umbilical cord using a needle guided by ultrasound. Report of 66 cases. Prenat Diagn. Oct 1983;3(4):271-7. [Medline].

  11. Grant J, Hyslop M. Underutilization of Rh prophylaxis in the emergency department: a retrospective survey. Ann Emerg Med. Feb 1992;21(2):181-3. [Medline].

  12. Issitt PD. Race-related red cell alloantibody problems. Br J Biomed Sci. Jun 1994;51(2):158-67. [Medline].

  13. Kleihauer E, Braun H, Betke K. Demonstation von fetalem Haemoglobin in den Erythrozyten eines Blutausstrichs. Klin Wochenschr. 1957;35:637-8.

  14. Mourant AE, Kopec AC, Domaniewska-Sobczak K. The Distribution of the Human Blood Groups and Other Biochemical Polymorphisms. 2nd ed. London, England: Oxford University Press; 1976.

  15. Peterec SM. Management of neonatal Rh disease. Clin Perinatol. Sep 1995;22(3):561-92. [Medline].

  16. Reece EA, Copel JA, Scioscia AL, Grannum PA, DeGennaro N, Hobbins JC. Diagnostic fetal umbilical blood sampling in the management of isoimmunization. Am J Obstet Gynecol. Nov 1988;159(5):1057-62. [Medline].

  17. Selinger M. Immunoprophylaxis for rhesus disease--expensive but worth it?. Br J Obstet Gynaecol. Jun 1991;98(6):509-12. [Medline].

  18. Walker RH. American Association of Blood Banks Technical Manual. 11th ed. Bethesda, Md: AABB; 1993.

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Further Reading

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Keywords

Rh incompatibility, rhesus factor, Rh disease, Rh factor, Rh-negative blood type, Rh-positive blood type, Rh antibodies, maternal Rh antibodies, Rh antigens, Rh sensitization, Rh blood group, Rh immunoglobulin G, Rh IgG, type O blood, O negative blood, Rh-positive fetal blood

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Contributor Information and Disclosures

Author

Leon Salem, MD, MS, Associate Attending Physician, Kaiser Permanente, Southern California
Leon Salem, MD, MS is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Karen R Singer, PA-C, Department of Pediatrics, Fountain Valley Medical Center, South Counties Pediatric Critical Care Medical Group, Fountain Valley and Long Beach, California
Karen R Singer, PA-C is a member of the following medical societies: American Academy of Physician Assistants
Disclosure: Nothing to disclose.

Medical Editor

Assaad J Sayah, MD, Chief, Department of Emergency Medicine, Cambridge Health Alliance
Assaad J Sayah, MD is a member of the following medical societies: National Association of EMS Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark Zwanger, MD, MBA, Assistant Professor, Department of Emergency Medicine, Thomas Jefferson University
Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association
Disclosure: Medicines Company Consulting fee Consulting; Pfizer Salary Employment

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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