The Rhesus-negative woman

O36.0 + (Z29.1)

GENERAL MEASURES

Maternal serum antibodies absent

Prevention

Test for maternal serum antibodies at ‘booking’, 28 and 34 weeks’ gestation.
During pregnancy, give prophylactic anti-D immunoglobulin to the mother within 72 hours of a potentially sensitising event.

MEDICINE TREATMENT

After a termination of pregnancy (TOP), miscarriage, ectopic pregnancy or amniocentesis <20 weeks:

  • Anti-D immunoglobulin, IM, 100 mcg.

LoEIII [40]

After external cephalic version:

  • Anti-D immunoglobulin, IM, 100 mcg.

At birth, determine the Rh status of the cord blood and request a Coomb’s test:

Cord blood Rh negative - no treatment.
Cord blood Rh positive, Coomb’s negative:

  • Anti-D immunoglobulin, IM, 100 mcg.

If a large feto-maternal transfusion is suspected:

  • Anti-D immunoglobulin, IM, 300 mcg for every 30 mL transfusion.
    • Maximum dose: 1 200 mcg.

AND

Do a maternal blood Kleihauer test (consult a specialist).

Rh positive, Coomb’s positive:

In these cases the mother will also have antibodies.
Do not administer anti-D immunoglobulin.

Maternal serum antibodies present

Consult a specialist.