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Rhesus iso-immunization 

Rhesus iso-immunization
Chapter:
Rhesus iso-immunization
Author(s):

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

DOI:
10.1093/med/9780192631732.003.0018
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date: 23 October 2019

Rhesus hemolytic disease of the fetus and newborn, while by no means the frequent condition that it once was, remains a problem that requires constant vigilance and attention. Although effective prophylaxis is available it must be properly used. Postpartum prophylaxis with anti-D immunoglobulin should be given within 72 hours of birth to all RhD-negative women who give birth to a RhD-positive baby, or a baby whose RhD status cannot be determined, irrespective of their ABO status. Anti-D immunoglobulin should be administered also to all RhDnegative women during pregnancy when there is an increased risk of fetomaternal bleeding. Routine use of anti-D immunoglobulin at 28 or 34 weeks of pregnancy for all Rh-negative women is of value as well, but the costs of such a programme are high and together with the limited supplies of anti-D immunoglobulin may preclude this in some countries. Rhesus iso-immunization has become sufficiently rare, and the treatment sufficiently complex, to warrant regionalization of care for these women and babies. Hopefully, this may facilitate adequate evaluation of the methods used for diagnosis and treatment, none of which have been as yet subjected to controlled trials.

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