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The initiation of cell-mediated immunity can be observed as early as the third month of fetal growth, with active antibody-mediated immunity following approximately one month later.
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Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
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AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
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Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management.

Tanushree Sahoo1, Madhushree Sahoo2, Krishna Mohan Gulla3

  • 1Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. tanushree_sony206@yahoo.co.in.

Indian Journal of Pediatrics
|July 2, 2020
PubMed
Summary

Rh alloimmunisation causes severe newborn jaundice and brain damage, especially in lower-middle income countries. Early detection and management, including Anti-D prophylaxis, significantly improve outcomes for Rh-sensitized pregnancies.

Keywords:
Bilirubin induced neurological damageDouble volume exchange transfusionHyperbilirubinemiaIntrauterine transfusionPhototherapyRh alloimmunisationRh isoimmunisation

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatology
  • Immunology

Background:

  • Rh alloimmunisation is a major cause of preventable neonatal hyperbilirubinemia and neuro-morbidity in lower-middle income countries.
  • Low uptake of antenatal Anti-D prophylaxis and inadequate follow-up contribute to the problem.
  • Undiagnosed cases can lead to severe hyperbilirubinemia and kernicterus in newborns.

Purpose of the Study:

  • To highlight the importance of awareness and education for healthcare professionals regarding Rh alloimmunisation.
  • To emphasize the need for early detection and timely management in both antenatal and postnatal periods.
  • To review current preventive and management strategies for Rh alloimmunisation.

Main Methods:

  • Review of existing literature on Rh alloimmunisation, Anti-D prophylaxis, and management protocols.
  • Analysis of the impact of antenatal and postnatal care on Rh alloimmunisation incidence and outcomes.
  • Discussion of diagnostic tools like indirect Coombs test and Doppler velocimetry.

Main Results:

  • Two doses of Anti-D prophylaxis (antenatal and postnatal) can reduce Rh alloimmunisation incidence to less than 1%.
  • Antenatal surveillance involving serial indirect Coombs tests and middle cerebral artery Doppler velocimetry is recommended.
  • Postnatal management includes phototherapy and, in select cases, exchange transfusion.

Conclusions:

  • Effective antenatal and postnatal management significantly improves the prognosis of Rh alloimmunised pregnancies.
  • Long-term outcomes for infants born from Rh alloimmunised pregnancies are comparable to those without alloimmunisation with appropriate care.
  • Increased awareness and professional education are crucial for reducing the burden of Rh alloimmunisation.