Only $2.99/month

Terms in this set (209)

- Only IgG antibodies are of concern, as they can cross the placenta; IgM antibodies do not. If the antibody identified is known to cause HDN, the amount of antibody in maternal serum is determined and evaluated over the progression of the pregnancy. The critical titer level for each antibody differs. All women with a positive antibody screen of a clinically significant antigen should have further evaluation, and those with critical titer levels may require the care of a maternal fetal medicine specialist.
- With regards to sensitized Rh D negative women, identifying paternal blood type and antibody status can be done. If paternity is certain and the father is Rh negative, no further management is necessary.
- If paternal blood type is unknown or is Rh positive, fetal blood group is determined by chorionic villi sampling, fetal blood sampling, or cell free fetal DNA (cffDNA) testing, if available (Vivanti et al., 2016). If the fetus is Rh D positive, the amount of maternal serum anti D is monitored regularly and serial ultrasound scans are done to evaluate severity of HDN. Active hemolysis is indicated by a rising level of maternal anti D. Serial Doppler assessment of the peak systolic velocity in the middle cerebral artery (MCA) is the standard to detect fetal anemia. If a fetal blood test confirms anemia, depending on its severity, a blood transfusion can be done in utero to replace the lysed fetal RBCs. Blood transfusions may also be needed to correct anemia in the newborn period. During this period, there may also be a sharp rise in the level of bilirubin in the neonate, which can be lowered by phototherapy and exchange transfusions.