see also: [[Pregnant trauma]], [[haemolytic disease of newborn]] #ob-gyn > [!summary] > Rh D immunoglobulin (Anti D) should be given to **Rh D negative women** who have no pre-formed anti-D antibodies during pregnancy if they experience a **sensitising** event in which there is a risk of fetal blood crossing into the maternal circulation > > should be given with *72 hours* for successfull immunoprophylaxis; can give up to 10 days after > > **Dose:** ==625 IU== IM > > [!warning] we give to prevent [[haemolytic disease of newborn]] # indications ==mum is rhesus negative and bub is resus positive== + a *sensitising event* - miscarriage > 12 weeks - termination of pregnancy - abdominal trauma - bleeding at birth - ectopic pregnancy - normal delivery with bub rh+ and mum rh- If mum Rh(-) and bub Rh(+) mix, then mum makes anti-D antibodies against bub's blood → in future pregnancies, antibodies mum makes can **cross placenta** and cause haemolytic disease of the newborn → elevated bilirubin → [[neonatal jaundice]] ↑ Anti-D injection circulates around mum's blood and **destroys bub's blood before mum's blood has opportunity to launch immune response** → prevent mum from becoming sensitised and developing her own antibodies against rhesus antigen ## Sensitising events < 12 weeks gestation - low risk of sensitisation - threatened miscarriage <12 weeks generally not an indication for anti-D - can consider anti-D in those without anti-D abs with heavy/repeated bleeding or a.w abdo pain or significant trauma ; ==check local guidelines== - give 250 IU # Adverse reactions - mild fever - malaise - rare allergic rxn # Kleihauer–Betke test - *quantifies* the magnitude of fetal-maternal mixing to determine if increased doses of anti-D are required # Dose give enough anti-D to provide 100 IU of antibody per 1mL of Rh positve fetal RBC in maternal circulations - generally 250 IU in single pregnancy <12 weeks - 625 IU multiple pregnancy or >12 weeks (note the RMH guideline just has 625 for all) # Related Questions ## delivery - [ ] 2Q: [Delivery](x-devonthink-item://85167CB5-A7B5-4BF3-9BC7-AC46D5538A42?page=9) -- [Answer](x-devonthink-item://5B03E66C-E043-4EB7-A5F6-7389CB927BD7?page=12) ## ectopic - [ ] 4Q: [First Trimester Bleeding](x-devonthink-item://0987D972-A221-4F8A-B7D7-B0DCC349A2B3?page=8) -- [Answer](x-devonthink-item://C7FCB01A-E668-44AF-8C95-C298A40F8D68?page=6) ## ectopic pregnancy - [ ] 5Q: [Ectopic Pregnancy](x-devonthink-item://A8F2D7A0-9A26-4012-AF42-19D640D674B4?page=8) -- [Answer](x-devonthink-item://A10DE51E-92FA-42D1-8AA0-7AE68C2FA743?page=4) - [x] 6Q: [Abdominal Pain and Collapse](x-devonthink-item://6092BF31-E542-4019-8E17-0C628DD3B0F1?page=2) -- [Answer](x-devonthink-item://E15CEB64-C6A5-4A7D-84B4-E7D1DC667B0E?page=1) -- [prop](x-devonthink-item://B3E266DE-B0B2-4F19-9986-B7C6FD455008?page=1) ## miscarriage - [ ] 12Q: [First trimester bleeding](x-devonthink-item://93BDB055-D606-4878-9FA5-0BEFF977FEF7?page=11) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=5) - [x] DUPLICATE Q: [First Trimester Bleeding](x-devonthink-item://0987D972-A221-4F8A-B7D7-B0DCC349A2B3?page=8) -- [Answer](x-devonthink-item://C7FCB01A-E668-44AF-8C95-C298A40F8D68?page=6) ## neonatal jaundice - [ ] 13Q: [Neonatal Jaundice](x-devonthink-item://4134DDB3-6E12-474A-9F6F-64135C0C6048?page=10) -- [Answer](x-devonthink-item://AC92B5F1-8EE6-461A-B03E-F70AE7DC1275?page=10) - [ ] 14Q: [Neonatal Jaundice](x-devonthink-item://834C484F-DDAA-4819-8DF0-84AE5E70DA1D?page=21) -- [Answer](x-devonthink-item://D46998FE-62E2-4A3A-860D-C32C94B86E42?page=9) - [ ] 15Q: [Neonatal Jaundice](x-devonthink-item://CA4D5561-277D-47A1-9EC2-E0DB4C59DCFD?page=2) -- [Answer](x-devonthink-item://2551B51B-0E7C-448E-9FB5-3B547E74974A?page=2) - [ ] 16Q: [Neonatal Jaundice](x-devonthink-item://7061D1B4-0AB9-4963-B3B0-23BDD975B2CD?page=9) -- [Answer](x-devonthink-item://3F30C77E-E23E-4200-89FE-48A41618E0C2?page=6) - [ ] 17Q: [Neonatal Jaundice](x-devonthink-item://73409C77-B2FA-4E0A-AEB3-5EB284457F0C?page=31) -- [Answer](x-devonthink-item://5A848952-80E3-4184-B553-368412A69917?page=21) - [ ] 18Q: [Neonatal Jaundice](x-devonthink-item://4BF6800D-0EC2-4637-A444-F2BC7D2E380C?page=8) -- [Answer](x-devonthink-item://9F437E5A-02D4-43FC-B795-5386EDE954F3?page=5)