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Medical Science Optional daily answer writing practice for CSE 2023 – Nov 14

Topic: Preeclampsia and Toxaemias of pregnancy

Question: Describe in detail the steps to be taken to prevent Rh-isoimmunisation.

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Detailed steps to prevent Rh-isoimmunisation:

1. Blood grouping and Rh typing should be done during the first antenatal visit for all pregnant women.

2. Women who are Rh-negative should get an indirect Coombs test done during antenatal period to detect atypical antibodies against Rh-positive cells.

3. Rh-negative women should receive anti-D immunoglobulin prophylaxis during pregnancy:

– First dose at 28-32 weeks of gestation
– Second dose within 72 hours of delivery if the newborn is Rh-positive

4. In case of potential sensitizing events – abortions, ectopic pregnancy, antepartum hemorrhage, abdominal trauma, invasive procedures like amniocentesis – Rh-negative women should get anti-D immunoglobulin within 72 hours.

5. During delivery, cord blood from the neonate should be taken for blood grouping and direct Coombs test.

6. If the neonate is Rh-positive, the mother should receive anti-D immunoglobulin within 72 hours of delivery. The dose is based on the presence of weak D antigen in the mother.

7. If the neonate is Rh-negative, no postpartum anti-D is required even if the mother is Rh-negative.

8. After antibody sensitization occurs, serial titres should be monitored. Sensitized pregnancies require serial doppler scans for fetal anemia and need specialized care.

9. In subsequent pregnancies, Rh-negative women should continue to receive anti-D immunoglobulin as per schedule.

10. Partners of Rh-negative women can be tested – if the partner is Rh-negative, no further testing is required.

Following these steps is key to preventing immunization and hemolytic disease of the newborn due to Rh-isoimmunisation.

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