Rh- Incompability

Rh incompatibility occurs when a mother and her unborn child have differing Rh protein factors. It happens when the mother is Rh-negative and her child is Rh-positive. The Rh factor is a protein that can be found on the surface of red blood cells.

Your Rh factor type, like your blood type, is inherited from your parents. The majority of people are Rh-positive, although a small minority are Rh-negative. This suggests they are deficient in the Rh protein. Your Rh factor is indicated by a positive or negative symbol following your blood type. "Blood type: AB+," for example, could be written on your medical record.

Your Rh factor has no direct impact on your health. The Rh factor, on the other hand, becomes significant during pregnancy. If a woman is Rh-negative and her kid is Rh-positive, her body will recognize the Rh-positive protein as foreign.

This implies that if your baby's blood cells cross into your bloodstream, which can happen throughout pregnancy, labor, and delivery, your immune system will produce antibodies against your baby's red blood cells. Antibodies are components of your immune system. They eliminate foreign substances.

Once your body produces these antibodies, you are deemed sensitive to your baby if you have an Rh-negative blood type. This implies your body could transfer antibodies across the placenta to assault your baby's red blood cells. The organ that joins you and your baby is the placenta.

Causes

During pregnancy, the placenta allows red blood cells from the unborn baby to enter the mother's blood.

If the mother is Rh-negative, her immune system perceives Rh-positive fetal cells as foreign. Antibodies are produced by the mother's body against the fetal blood cells. These antibodies may pass the placenta and enter the developing infant. They kill the baby's red blood cells in circulation.

Bilirubin is produced when red blood cells are broken down. A newborn will turn yellow as a result of this (jaundiced). Bilirubin levels in the infant's circulation can range from mild to dangerously high.

First-born children are rarely impacted unless the mother has had previous miscarriages or abortions that have sensitized her immune system. This is due to the fact that it takes time for the mother to build antibodies. However, all subsequent Rh-positive children she has may be affected.

Only when the mother is Rh-negative and the infant is Rh-positive does Rh incompatibility occur. This issue has become less prevalent in areas that provide high-quality prenatal care. This is due to the widespread use of RhoGHAM immune globulins.

Signs and Symptoms

Rh incompatibility can result in symptoms ranging from mild to fatal. Rh incompatibility, in its mildest form, results in the death of red blood cells. There are no other effects.

After birth, the infant may have:

• Yellowing of the skin and whites of the eyes (jaundice)
• Low muscle tone (hypotonia) and lethargy

Effects of Rh-incompatibility

Fetal Effect:

• Anemia is caused by the destruction of fetal RBCs and lasts throughout the pregnancy.
• Fetal erythroblastosis
• Details about hydrops: Intrauterine fetal death is caused by tissue hypoxia and acidosis.

Neonate Effects:

• Congenital hemolytic anemia
• Hyperbilirubinaemia

Exams and Tests

The woman may have extra amniotic fluid surrounding her unborn baby before delivery (polyhydramnios). There could be:

• A direct Coombs test result that is positive
• Bilirubin levels in the baby's umbilical cord blood are higher than normal.
• Red blood cell breakdown is visible in the infant's blood.

Treatment

The management will be done under:

• The Rh-negative unsensitized patients
• The Rh-negative sensitized patients

Management of Rh-negative unsensitized patient

1. At the initial antenatal visit, all pregnant women should be tested for blood ABO and RH groups.
2. If the lady is Rh-negative, she should collect her husband's ABO and Rh group and have her blood tested for antibiotics.
3. Gather prior obstetric history.
4. Repeat maternal blood testing for Rh antibodies at 35 weeks. If the results are negative, keep an eye on her until she gives birth. If positive, treat her as you would any other Rh-sensitive patient.
5. Collect the baby's cord blood at birth and send it to be tested for direct coomb's test, Hb, bilirubin, and ABO/Rh group of a newborn baby.
6. Following birth, give 300 ugs Rh anti-D immunoglobulin IM and 150 ug anti-D immunoglobulin within 72 hours, preferably sooner.
7. Check the infant's condition carefully for any anomalies; closely monitor the newborn for the first 24 hours because hemolytic jaundice may develop.

Management of Rh-negative sensitized patient

1. A USG at roughly 16 weeks is recommended to check gestational maturity, and placenta placement, and detect any anomalies.
2. At 28 weeks of gestation, amniotic fluid analysis is performed to provide information for continued prenatal care of the present pregnancy.

• The moderately impaired fetus is healthy, and maturity has been reached. When fetal lung maturity is reached, it may be essential to initiate pregnancy in a moderately afflicted fetus. A severely damaged fetus should be closely monitored.
• The treatment focuses on mitigating the impacts of incompatibility. In minor circumstances, the newborn can be treated immediately after birth with: a series of blood transfusions
• fluids that hydrate
• Electrolytes are substances that influence metabolism.

Phototherapy

Phototherapy includes exposing your infant to fluorescent lights in order to lessen the amount of bilirubin in their blood. These steps may be repeated as needed until the Rh-negative antibodies and excess bilirubin have been eliminated from your baby's blood. The severity of your baby's disease will determine if it needs to be repeated.

If you are pregnant and your doctor discovers that you have antibodies against your baby, your pregnancy will be constantly examined.

You can avoid the effects of Rh incompatibility by receiving an injection of Rh immune globulins (RhIg) during your first trimester, if you have a miscarriage, or if you have any bleeding during your pregnancy. This blood product contains Rh factor antibodies. You should get a second injection a few days later if your kid has Rh-positive blood.

Complication

• Brain injury caused by excessive bilirubin levels (kernicterus)
• Swelling and fluid buildup in the baby (hydrops fetalis)
• Mental function, mobility, hearing, speech, and seizure issues

Prevention

1. Rh incompatibility is virtually entirely avoidable. During pregnancy, Rh-negative moms should be regularly monitored by their doctors.
2. RhoGAM, or special immune globulins, are now utilized to prevent RH incompatibility in Rh-negative mothers.
3. If the father is Rh-positive or his blood type is unknown, the mother is given a RhoGAM injection during the second trimester. If the infant is Rh-positive, the mother will receive a second injection shortly after delivery.
4. Antibodies against Rh-positive blood are prevented by these injections. Women with Rh-negative blood types, on the other hand, must receive injections:

• During every pregnancy
• After a miscarriage or abortion
• After prenatal tests such as amniocentesis and chorionic villus biopsy
• After an injury to the abdomen during pregnancy

Nursing Management for Rh-incompatibility

Nursing diagnoses for Rh incompatibility

• Risk of harm from breaking down RBC products in higher quantities than normal, as well as functional immaturity of the liver.

Goals

• Will be given suitable treatment to help with bilirubin excretion.
• There will be no side effects from phototherapy.
• There will be no issues from the exchange transfusion.
• R/T infant with an interrupted familial process and a potentially harmful physiologic reaction.
• Emotional support will be provided to the family.
• The family will be prepared to care for the newborn at home.

Nursing Care for Rh incompatibility

During Phototherapy

1. Remove your garments to allow for proper skin exposure.
2. Turn the infant regularly to expose all of the skin.
3. Record and report jaundice and bilirubin levels in the blood.
4. Keep track of and report any changes in body temperature.
5. To avoid eye injuries, use eye patches to cover and inspect your eyes.
6. To avoid corneal discomfort, shut the eyes before applying the eye patch.
7. It should be slack enough to avoid being pressed.
8. Eye patches should be changed every eight hours, and eye care is provided.
9. Because of photodegradation products, the nurse should expect the infant's feces to be green and the urine to be black.
10. Serum bilirubin and hematocrit levels should be monitored during and for 24 hours after treatment.
11. Milk jaundice momentarily halts breastfeeding in the case of the breast.
12. To avoid dehydration, keep feeding intervals consistent.