Rh Incompatibility Clinical Presentation

Updated: Mar 15, 2017
  • Author: Leon Salem, MD, MS; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Presentation

History

Obtain the following history:

  • History of prior blood transfusion
  • Rh blood type of the mother
  • Rh blood type of the father (55% of Rh-positive men are genetically heterozygous for the Rh antigen and, therefore, produce Rh-negative offspring when mating with Rh-negative women 50% of the time.)
  • Previous pregnancies, including spontaneous and elective abortions
  • Previous administration of Rh IgG (RhoGAM)
  • Mechanism of injury in cases of maternal trauma during pregnancy
  • Presence of vaginal bleeding and/or amniotic discharge
  • Previous invasive obstetric procedures, such as amniocentesis, cordocentesis, chorionic villous sampling, or ectopic pregnancy

Note that a large fetal-maternal hemorrhage may occur without symptoms and with little or no evidence of trauma. Therefore, a high index of suspicion is warranted and a low threshold for treatment is indicated.

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Physical

Evaluation of the vital signs and primary survey of the airway and cardiovascular system are indicated to ensure maternal stability.

A thorough pelvic examination is required.

In situations in which abdominal and/or pelvic trauma is a consideration, inspect for evidence of bruising that may suggest the possibility of significant fetomaternal hemorrhage.

When an infant with an Rh-negative mother is delivered in the emergency department, a thorough physical examination of the infant must be performed after initial stabilization, and a neonatal clinician must be consulted immediately.

Physical findings may vary from mild jaundice to extreme pallor and anemia with hydrops fetalis.

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Causes

Factors that influence an Rh-negative pregnant female's chances of developing Rh incompatibility include the following:

  • Ectopic pregnancy
  • Placenta previa
  • Placental abruption
  • Abdominal/pelvic trauma
  • In utero fetal death
  • Any invasive obstetric procedure (eg, amniocentesis)
  • Lack of prenatal care
  • Spontaneous abortion
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