Rh incompatibility And Nursing Care

Rh incompatibility



15% of the world’s population is Rh-negative. Rh incompatibility is a risk when an Rh negative woman carry a fetus which is Rh  positive.
Rh incompatibility results from an antigen-antibody reaction (alloimmunization).
When an Rh positive fetus grows inside an Rh negative woman there is chance for fetal blood enter into maternal circulation at the time of an abortion or placental separation.

Rh incompatibility

Mother starts producing Rh antibodies against the Rh antigen entered from fetal blood.
If the pregnancy is continued or at the second time she become pregnant with an Rh positive fetus, the Rh antibodies cross placenta and enter fetal circulation destroying fetal RBCs.
The fetus develops anemia, jaundice, cardiac failure (hydrops fetalis) and neurological damage (kernicterus).

Rh incompatibility

Rh incompatibility

Clinical manifestations

•    Jaundice appearing in the 1st 24 hours.
•    Serum bilirubin (unconjugated) rises rapidly.
•    Anemia from hemolysis.
•    Hepatosplenomegaly
•    Hydrops and hypovolumic shock in severe cases
•    Hypoglycemia from pancreatic hyperplasia

Early Diagnosis – Pregnancy for Rh incompatibility

•    H/O previous blood transfusions
•    Blood group and Rh status of pregnant woman
•    Rh antibody titer for Rh negative woman at the first pregnancy visit and repeat at 32-38 weeks of pregnancy (ICT)
Normal titer is    0
Minimal ratio     1:8
•    Chorionic villus sampling in early pregnancy.
•    Amniocentesis and amniotic fluid spectrophotometry for biliribin
•    Regular ultrasound from 14-18 weeks onwards – look for fetal ascites and subcutaneous edema (hydrops fetalis)

Early Diagnosis – After Birth for Rh incompatibility

•    Determination of fetal blood group and test for alloimmunization (DCT) from cord blood at the time of delivery.

Management

In Pregnancy
•    Intrauterine blood transfusion with Rh negative blood in case of fetal anemia.
After Delivery
•    Phototherapy
•    Exchange transfusions with Rh (-) blood.
•    In severe cases with hydrops
–    Pericardial or pleural fluid aspiration
–    Mechanical ventilatory support
–    Inotropic therapy

Nursing management for Rh incompatibility

 

Nursing diagnoses for Rh incompatibility
•    Risk for injury from breaking down products of RBCs in greater numbers than normal and functional immaturity of the liver.
Goals
•    Will receive appropriate therapy to accelerate bilirubin excretion.
•    Will experience no complications from phototherapy.
•    Will experience no complications from exchange transfusin.
•    Interrupted family process R/T infant with potentially adverse physiologic response.
•    Family will receive emotional support.
•    Family will be prepared for home care of the neonate.

NURSING CARE for Rh incompatibility DURING PHOTOTHERAPY
1.     Remove clothing to proper skin exposure.
2.     Turn infant frequently to expose all skin area.
3.     Record and report jaundice and blood levels of bilirubin.
4.     Record and report if any change in body temperature
5.     Cover and check eyes with eye patches to prevent eye injury.
–    Be sure the eyes close before applying eye patch to prevent
corneal irritation
–    Should be  loose enough to avoid pressure.
–    Eye patches should be changed every 8houly and eye care
given.
6.     Nurse should expect the infant’s stools to be green and the
urine dark because of photodegradation products.
7.     Serum bilirubin and hematocrit should be monitored during
therapy and for 24 hours following therapy.
8.     In case of breast milk jaundice stop breast feeding
temporarily.
9.     Maintain feeding intervals to prevent dehydration.

Prevention for Rh incompatibility
•    Screening for the blood group of all pregnant women.
•    Arrange for further investigations if the woman is Rh negative.
•    Anti D (RhoD or RhoGAM) injection 300µg IM for the mother at 28 weeks of gestation.
•    Anti D (RhoD or RhoGAM) injection 300µg IM for the mother within 72 hours of an abortion, delivery of Rh positive baby or after procedures like amniocentesis or chorionic villus sampling.

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