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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.
Insights
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.
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.
Abstract:
In spite of advances in medical science, Rh alloimmunisation remains one of the leading causes of preventable neuro-morbidities and significant neonatal hyperbilirubinemia in lower-middle income countries. Despite availability of effective antenatal preventive strategy (Anti-D), its uptake in antenatal period is low due to ignorance. Further, once diagnosed, there is lack of adequate antenatal follow up in health care facility. Some of these cases even remain undiagnosed in antenatal period only to present as a case of severe hyperbilirubinemia and kernicterus in late neonatal period. Thus, there is an urgent need for creating awareness and educating health care professionals for early detection and timely management in both antenatal and postnatal period. Following two doses of anti-D prophylaxis (one in antenatal period and one in immediate postnatal period) the incidence of Rh alloimmunisation can reduce to <1%. It is recommended to follow all Rh alloimmunised pregnancies antenatally with serial indirect Coombs test titre (till critical titre is reached) followed by serial Doppler velocimetry of middle cerebral artery in a perinatal centre where facility for intrauterine transfusion as well as advanced neonatal care is available. Postnatal management of these infants comprises of confirmation of diagnosis, aggressive phototherapy and in selective cases, double volume exchange transfusion. With appropriate antenatal and postnatal management, the prognosis of Rh alloimmunised pregnancy remains favourable and long term outcome of Rh alloimmunised infants remain comparable with their normal counterparts.
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