All women should receive ABO and Rh typing as part of routine care at their first prenatal visit. The patient in this case did not obtain prenatal care for her first pregnancy and would not have obtained it for the second pregnancy until she presented to the hospital with food poisoning. Some good can come from "bad" fish tacos!
Like the ABO system, typing for Rh involves determining the presence (+) or absence (—) of carbohydrate antigens. An indirect Coombs test detects antibodies (such as anti-Rh) in the maternal blood. In this test, maternal serum is mixed with stock Rh+ cells. If antibodies to Rh are present, they bind the cells and cause agglutination. Maternal serum anti-Rh titers are followed through the course of the pregnancy if necessary.
To prevent hemolytic disease of the newborn, one dose of purified anti-Rh immuno-globulin (RhoGAM®) is given to Rh-negative mothers in their third trimester, when transplacental hemorrhage is most likely (28-32 weeks' gestation), and again within 72 hours of delivery. Amniocentesis, spontaneous or induced abortion, ectopic pregnancy, hydati-diform mole, chorionic villus sampling, percutaneous umbilical blood sampling, or abdominal trauma—all situations where alloimmunization may occur—are other indications for RhoGAM® for the protection of a current or future pregnancy. A single dose is sufficient to neutralize the immune response to 30 mL of fetal blood, with protection lasting 12 weeks. The mechanism of action of RhoGAM® is not completely understood, but it appears to facilitate removal of fetal red blood cells from maternal circulation, preventing the ability for alloimmunization. With the successful use of RhoGAM®, hemolytic disease of the newborn affects only about 0.1% of at-risk fetuses.
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