Below is a **complete, concise-but-exhaustive medical reference** for **Rh-negative pregnancy**, followed by **SEO title, description, keywords**, and an **auto-generated image**.

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# ⭐ **RH-NEGATIVE PREGNANCY — COMPLETE DETAILS**







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# 1️⃣ **Definition**

**Rh-negative pregnancy** occurs when a pregnant woman is **Rh-negative (D antigen absent)** and her fetus is **Rh-positive (inherited from father)** → risk of **Rh alloimmunization** and **Hemolytic Disease of Fetus & Newborn (HDFN)** if fetal RBCs enter maternal circulation.

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# 2️⃣ **Pathophysiology (Stepwise)**

1. Fetal Rh-positive RBCs enter maternal blood (fetomaternal hemorrhage).
2. Maternal immune system recognizes Rh(D) antigen.
3. Primary immune response → **IgM (does NOT cross placenta)**.
4. Secondary exposure → **IgG anti-D antibodies (cross placenta)**.
5. IgG binds fetal RBCs → hemolysis → fetal anemia → high-output cardiac failure → **hydrops fetalis**, hyperbilirubinemia, kernicterus.

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# 3️⃣ **Causes of Fetomaternal Hemorrhage**

* Delivery (most common)
* Miscarriage or abortion
* Ectopic pregnancy
* Amniocentesis, CVS, cordocentesis
* Trauma (MVA, domestic violence)
* Placental abruption, placenta previa bleed
* External cephalic version

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# 4️⃣ **Clinical Features of Affected Fetus**

* Mild → anemia
* Moderate → hepatosplenomegaly
* Severe → hydrops fetalis (ascites, pleural/pericardial effusion, skin edema)
* High-output cardiac failure
* Polyhydramnios
* Neonatal jaundice → kernicterus

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# 5️⃣ **Investigations**

### **Maternal**

* **Blood group & Rh typing**
* **Indirect Coombs Test (ICT) / Antibody screen**

* Negative → not sensitized
* Positive → alloimmunized
* **Antibody Titre Monitoring**

* Critical titre **≥1:16** (varies by lab)

### **Paternal**

* **Rh typing**
* **Zygosity test** (heterozygous = 50% risk)

### **Fetal**

* **Cell-free fetal DNA (cffDNA)** → fetal RhD status
* **MCA-PSV Doppler**

* > 1.5 MoM → moderate/severe fetal anemia
* Ultrasound → hydrops, placentomegaly
* **Cordocentesis** (confirm anemia when intervention planned)

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# 6️⃣ **Management Based on Status**

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## **A. RH-NEGATIVE, UNSENSITIZED MOTHER**

Goal → **Prevention of alloimmunization**

### **Anti-D Prophylaxis**

* **Routine antenatal prophylaxis:**

* **300 µg (1500 IU)** IM at **28 weeks**
* **Postpartum prophylaxis:**

* **300 µg** within **72 hours after delivery** if baby is Rh-positive
* **After sensitizing events:**

* <12 weeks: **50 µg (250 IU)**
* > 12 weeks: **300 µg (1500 IU)**

### **Kleihauer–Betke Test / Flow Cytometry**

Used to calculate fetal bleed volume → adjust Anti-D dose.

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## **B. ALREADY SENSITIZED (ICT POSITIVE)**

Goal → **Monitor & treat fetal anemia**

### **Steps**

1. Determine **fetal RhD status** (cffDNA or amniocentesis).
2. If RhD positive → monitor **antibody titres** up to 28 weeks, then every 2 weeks.
3. Once titre ≥1:16 → perform **MCA-PSV Doppler** weekly.
4. If MCA-PSV >1.5 MoM → **severe fetal anemia** → manage:

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### **Management of Severe Fetal Anemia**

* **Intrauterine transfusion (IUT)** via cordocentesis

* O negative, leukocyte-reduced, irradiated RBCs
* Repeat every 2–4 weeks until 34 weeks
* Delivery planned at **37–38 weeks** after last IUT
* If hydrops persists → consider **early delivery** (≥32 weeks) if lung maturity adequate

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# 7️⃣ **Newborn Management**

* **Direct Coombs Test**
* Check hemoglobin, bilirubin, reticulocyte count
* **Phototherapy**
* **Exchange transfusion** if severe hyperbilirubinemia
* IVIG may reduce need for exchange transfusion

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# 8️⃣ **Complications**

### **Maternal**

* Alloimmunization (permanent)

### **Fetal**

* Hemolytic disease
* Hydrops fetalis
* Intrauterine death
* Prematurity due to early delivery
* Neurodevelopmental impairment (kernicterus)

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# 9️⃣ **Prevention Summary**

* Universal **Rh typing**
* **Prophylactic Anti-D** (antenatal + postnatal)
* Proper dosing after FMH events
* Avoid unnecessary invasive procedures

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# 🔟 **SEO CONTENT**

### ✔️ **SEO Title**

**Rh-Negative Pregnancy: Causes, Risks, Anti-D Prophylaxis, Diagnosis & Complete Management Guide**

### ✔️ **SEO Meta Description**

A complete, exam-ready guide to Rh-negative pregnancy: pathophysiology, causes, investigations, anti-D prophylaxis, management of sensitized vs unsensitized mothers, fetal monitoring, and complications.

### ✔️ **SEO Keywords (comma-separated)**

Rh negative pregnancy, Rh incompatibility, anti D prophylaxis, Rh isoimmunization, hemolytic disease of newborn, MCA PSV Doppler, Rh sensitization, hydrops fetalis, Rh typing, fetomaternal hemorrhage, indirect Coombs test, Rh antibodies, intrauterine transfusion

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# 🖼️ **Generated Medical Illustration**

(Concept: Rh-negative mother with Rh-positive fetus, IgG crossing placenta)



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