Question

How does management differ if a pregnant patient does not have a H/O fetus affected by Rh alloimmunization (as opposed to a + history)?

a) Same management
b) No Rh immunoglobulin needed
c) No further monitoring needed
d) Close monitoring for alloimmunization

Answer 1

The management for a pregnant patient without a history of Rh alloimmunization requires close monitoring and the preventive administration of Rho(D) immune globulin to avoid the risk of sensitization and hemolytic disease of the newborn (HDN) in Rh-negative mothers.

Step-by-step explanation:

In cases where a pregnant patient does not have a history (H/O) of fetus affected by Rh alloimmunization, management involves close monitoring, as there is still a potential risk for alloimmunization to occur in the current pregnancy. For Rh-negative mothers without the previous formation of anti-Rh antibodies (no history of Rh alloimmunization), administration of Rho(D) immune globulin (e.g., RhoGAM) is recommended as a preventive treatment. This medication is typically given during the 28th week of pregnancy and within 72 hours after delivery, as well as after any event that could result in fetal cells entering the maternal circulation. The correct answer to the student's question would be d) Close monitoring for alloimmunization.

RhoGAM works by binding to any Rh-positive fetal red blood cells that have entered the maternal bloodstream and preventing the mother's immune system from reacting to them and producing anti-Rh antibodies. This proactive approach importantly reduces the likelihood of hemolytic disease of the newborn (HDN) in current and future pregnancies.