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Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management.
Indian J Pediatr. 2020 Jul 01 [Online ahead of print]IJ

Abstract

In spite of advances in medical science, Rh alloimmunisation remains one of the leading causes of preventable neuro-morbidities and significant neonatal hyperbilirubinemia in lower-middle income countries. Despite availability of effective antenatal preventive strategy (Anti-D), its uptake in antenatal period is low due to ignorance. Further, once diagnosed, there is lack of adequate antenatal follow up in health care facility. Some of these cases even remain undiagnosed in antenatal period only to present as a case of severe hyperbilirubinemia and kernicterus in late neonatal period. Thus, there is an urgent need for creating awareness and educating health care professionals for early detection and timely management in both antenatal and postnatal period. Following two doses of anti-D prophylaxis (one in antenatal period and one in immediate postnatal period) the incidence of Rh alloimmunisation can reduce to <1%. It is recommended to follow all Rh alloimmunised pregnancies antenatally with serial indirect Coombs test titre (till critical titre is reached) followed by serial Doppler velocimetry of middle cerebral artery in a perinatal centre where facility for intrauterine transfusion as well as advanced neonatal care is available. Postnatal management of these infants comprises of confirmation of diagnosis, aggressive phototherapy and in selective cases, double volume exchange transfusion. With appropriate antenatal and postnatal management, the prognosis of Rh alloimmunised pregnancy remains favourable and long term outcome of Rh alloimmunised infants remain comparable with their normal counterparts.

Authors+Show Affiliations

Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. tanushree_sony206@yahoo.co.in.Department of Obstetrics and Gynaecology, SCB Medical College and Hospital, Cuttack, Odissa, 753007, India.Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32607667

Citation

Sahoo, Tanushree, et al. "Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management." Indian Journal of Pediatrics, 2020.
Sahoo T, Sahoo M, Gulla KM, et al. Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. Indian J Pediatr. 2020.
Sahoo, T., Sahoo, M., Gulla, K. M., & Gupta, M. (2020). Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. Indian Journal of Pediatrics. https://doi.org/10.1007/s12098-020-03366-0
Sahoo T, et al. Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. Indian J Pediatr. 2020 Jul 1; PubMed PMID: 32607667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rh Alloimmunisation: Current Updates in Antenatal and Postnatal Management. AU - Sahoo,Tanushree, AU - Sahoo,Madhushree, AU - Gulla,Krishna Mohan, AU - Gupta,Monica, Y1 - 2020/07/01/ PY - 2020/01/17/received PY - 2020/05/22/accepted PY - 2020/7/2/entrez KW - Bilirubin induced neurological damage KW - Double volume exchange transfusion KW - Hyperbilirubinemia KW - Intrauterine transfusion KW - Phototherapy KW - Rh alloimmunisation KW - Rh isoimmunisation JF - Indian journal of pediatrics JO - Indian J Pediatr N2 - In spite of advances in medical science, Rh alloimmunisation remains one of the leading causes of preventable neuro-morbidities and significant neonatal hyperbilirubinemia in lower-middle income countries. Despite availability of effective antenatal preventive strategy (Anti-D), its uptake in antenatal period is low due to ignorance. Further, once diagnosed, there is lack of adequate antenatal follow up in health care facility. Some of these cases even remain undiagnosed in antenatal period only to present as a case of severe hyperbilirubinemia and kernicterus in late neonatal period. Thus, there is an urgent need for creating awareness and educating health care professionals for early detection and timely management in both antenatal and postnatal period. Following two doses of anti-D prophylaxis (one in antenatal period and one in immediate postnatal period) the incidence of Rh alloimmunisation can reduce to <1%. It is recommended to follow all Rh alloimmunised pregnancies antenatally with serial indirect Coombs test titre (till critical titre is reached) followed by serial Doppler velocimetry of middle cerebral artery in a perinatal centre where facility for intrauterine transfusion as well as advanced neonatal care is available. Postnatal management of these infants comprises of confirmation of diagnosis, aggressive phototherapy and in selective cases, double volume exchange transfusion. With appropriate antenatal and postnatal management, the prognosis of Rh alloimmunised pregnancy remains favourable and long term outcome of Rh alloimmunised infants remain comparable with their normal counterparts. SN - 0973-7693 UR - https://www.unboundmedicine.com/medline/citation/32607667/Rh_Alloimmunisation:_Current_Updates_in_Antenatal_and_Postnatal_Management L2 - https://dx.doi.org/10.1007/s12098-020-03366-0 DB - PRIME DP - Unbound Medicine ER -
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