WHAT IS ISOIMMUNIZATION (RH INCOMPOATIBILITY) ?

This is a condition that occurs during pregnancy if a woman has Rhnegative blood and her baby has Rh-positive blood. Rh-negative and Rh-positive refer to wether your blood has rhesus factor(Rh factor).This is a protein in red blood cell, positive if you have it and negative if you dont have it..It can be inherited,i.e. passed from parents to children through the genes. Most people are Rh-positive. This is basically a problem that affects the fetus because when it begins to grow inside an Rh-negative mother who is sensitized, it is as though her body is being invaded by a foreign agent and her body reacts in the same manner it would be if the invading factor were a substance such as virus.The danger occurs if the fetal blood leaks through the placenta and mixes with the mothers blood,the mother becomessensitized to the rh antigen. The mother produces anti Rh antibodies that cross the placenta and cause agglutination and hemolysis of fetal blood cell. The Rh-factor exists as a portion of the red blood cell so these maternal antibodies cross the placenta and cause red blood cell destruction(hemolysis) of fetal red blood cell.A fetus can become so deficient in red blood cells that sufficient oxygen transport to body cells cannot be maintained. Theoretically,there is no connection between fetal blood and maternal blood during pregnancy,though it is documented that an occasional villus ruptures allowing a drop or two of fetal blood to enter the maternal circulation. ASSESSMENT; It is important that all women with Rh-negative blood should have an anti-D antibody titer done at a first pregnancy visit.If results are normal or minimal a ratio of 1:8 the test is is repeated at week 28 and if still normal there is no therapy needed. But if antibody titer is elevated 1:16 or greater the well- being of the fetus will be monitored every 2 weeks by Doppler velocity of the fetal middle cerebral artery,a technique that can predict when anemia is present.If the reading is low a fetus is in danger and immediate birth will be carried out or intrauterine transfusion or exchange will begin. Some test used to detect the abnormality: 1. Amniocentesis a needle is used to remove a small amount of fluid from the sac around the baby.The fluid is then tested for various reasons. 2. CVS - the doctor threads a thin tube through the vagina and cervix to the placenta.Then a tissue sample is removed from the placenta using gentle suction and tested for various reasons. Risks factors for having the abnormality: -earlier pregnancy (usually during pregnancy) - a miscarriage

-an induced abortion -a blood transfusion -bleeding during pregnancy SIGNS AND SYMPTOMS: Normally it does not show any symptom except in some cases like fever on the part of the mother .The threat yo the baby is much more serious and the condition can lead to hemolytic anemia,wherein red blood cell is destroyed faster than the body can replace them. Red blood cell contain hemoglobin,an iron rich protein that carries oxygen to your body,insufficient RBC and hemoglobin the blood can not carry enough oxygen to the body. Hemolytic anemia can cause mild to severe signs in newborn such as JAUNDICE a yellowish color of the skin or whites of the eyes and the cause of this is when RBC die they release hemoglobin into the blood,then this is broken down into a compound called bilirubin which gives the skin and eyes a yellowish color.High levels of this can lead to brain damage in the baby. Another sign is a build up of fluid as a result of heart failure GOAL OF TREATMENT: First is to ensure the health condition of the baby an to lower the risk of mother in future pregnancies. THERAPEUTIC MANAGEMENT; To reduce the number of Rh (D) antibodies being formed Rh-(D) immune globuline (RhIG) ,a commercial preparation of passive Rh (D) antibodies against the Rh factor is administered to women at 28 weeks of pregnancy. Arhaig is given again 72 hours after delivery of an Rhpositive child to prevent the mother from forming natural antibodies INTRAUTERINE TRANSFUSION is indicated if the artery velocity is low to restore fetal red blood cells on the fetus in utero.This is done by injecting red blood cell directly into a vessel in the fetal cord or depositing them in the fetal abdomen using amniocentesis technique. FETAL DEATH Obviously ,one of the most severe complications of pregnancy is fetal death.The most common causes include ; chromosomal abnormalities congenital malformations infections such as hepatitis B immunonologic causes complications of maternal diseasew

PREVENTION; -This can be prevented with Rh immune globulin if given at the correct times. -early prenatal care can also help prevent some of the problems linked to Rh Incompatibility - if at risk close monitoring during pregnancy and watch for signs of hemolytic anemia in the baby NURSING DIAGNOSIS AND INTERVENTION; Nursing Diagnosis: Powerlessness related to fetal death Intervention: