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Iso Immunization

Isoimmunization refers to a condition where an Rh-negative pregnant woman carries an Rh-positive fetus. This can lead to hemolytic disease of the newborn if left untreated. The major cause is exposure to Rh-positive fetal blood during pregnancy or delivery, which can sensitize the mother's immune system. Treatment involves prevention through prophylactic Rh immunoglobulin injections during and after pregnancy to desensitize the mother's blood. Nursing management includes assessing patients for Rh incompatibility and administering Rh immunoglobulin as ordered.

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Hazel Marie Echavez
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336 views

Iso Immunization

Isoimmunization refers to a condition where an Rh-negative pregnant woman carries an Rh-positive fetus. This can lead to hemolytic disease of the newborn if left untreated. The major cause is exposure to Rh-positive fetal blood during pregnancy or delivery, which can sensitize the mother's immune system. Treatment involves prevention through prophylactic Rh immunoglobulin injections during and after pregnancy to desensitize the mother's blood. Nursing management includes assessing patients for Rh incompatibility and administering Rh immunoglobulin as ordered.

Uploaded by

Hazel Marie Echavez
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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ISOIMMUNIZATION DEFINITION: It is known as Rh sensitivity or Rh incompatability.

It refers to a condition in which the pregnant patient is Rh negative and her fetus is Rh positive. If this condition is left untreated, isoimmunization can lead to hemolytic disease of the newborn. Before the development of RhoGAM (human), this condition was a major cause of kernicterus and neonatal death.

CAUSES AND RISK FACTORS: Being a pregnant woman with Rh-negative blood who had a prior pregnancy with a fetus that was Rh positive Being a pregnant woman with Rh-negative blood who did not receive Rh immunization prophylaxis during a prior pregnancy with an Rh-positive fetus incompatible blood transfusions previous fetal-maternal hemorrhage (ie ectopic pregnancy, abortion) procedures like amniocentesis and chorionic villi sampling sharing needles labour and delivery

SIGNS AND SYMPTOMS: There are no physical symptoms observed from the mother during the antenatal period. DIAGNOSTIC FINDINGS: 1. Increased concentration (optical density) of bilirubin and RBC breakdown products in the amniotic fluid 2. An anti-D antibody titer of 1:16 or greater 3. Radiologic studies possibly showing edema and in those with hydrops fetalis, the halo sign (edematous, elevated, subcutaneous fat layers) and the Buddha position (fetus legs are crossed) ETIOLOGY: The most common cause of Rh incompatibility is exposure from an Rh-negative mother by Rh-positive fetal blood during pregnancy or delivery. As a consequence, blood from the fetal circulation may leak into the maternal circulation, and, after a significant exposure, sensitization occur leading to maternal antibody production against the foreign Rh antigen.

TREATMENT: Since Rh incompatibility is almost completely preventable with the use of prophylactic immunization (immune globulin injection of RhoGAM), prevention remains the best treatment. 1. Immune Globulin Injection You will be given an injection of Rho immune globulin at week 28 of the pregnancy. This desensitizes your blood to Rh-positive blood. You will also have another injection of immune globulin within 72 hours after delivery (or miscarriage, induced abortion, or ectopic pregnancy). The injection further desensitizes your blood for future pregnancies. PATHOPHYSIOLOGY: 1. With isoimmunization, an antigen-antibody immunologic reaction within the body occurs when an Rh negative pregnant patient carries an Rh-positive fetus. 2. During the patients first pregnancy, an Rh-negative female becomes sensitized by exposure to Rh-positive fetal blood antigens inherited from the father. 3. A female may also become sensitized from receiving blood tranfusion with alien Rh antigens, causing agglutinins to develop; from inadequate doses of RhoGAM; or from failure to receive RhoGAM after significant fetal-maternal leakage from abruptio placentae. 4. Subsequent pregnancy with an Rh-positive fetus triggers increasing amounts of maternal agglutinating antibodies to cross the placental barrier, attach to Rh-positive fetus, and cause hemolysis and anemia. 5. To compensate for this, the fetus steps up the production of RBCs, and erythroblasts (immature RBCs) appear in the fetal circulation. 6. Extensive hemolysis results in the release of large amounts of unconjugated bilirubin, which the liver cant conjugate and excrete, causing hyperbilirubenemia and hemolytic anemia. Diagram:

NURSING MANAGEMENT: Assess all pregnant patients for possible Rh incompatability. Expect to administer RhoGAM I.M. as ordered to all Rh-negative patients after tranfusion reaction, ectopic pregnancy, spontaneous or induced abortion, or during the second and third trimester to patients with abruptio placentae, placenta previa, or amniocentesis. Prepare the patient for a planned delivery, usually 2 to 4 weeks before the term date, depending on the maternal history, serlogic tests and amniocentesis MEDICAL MANAGEMENT: Assist with intrauterine transfusion as indicated - Beforehand, obtain a baseline FHR through electronic monitoring and explain to the patient the procedure and its purpose - Afterward, carefully observe the patient for uterine contractions and fluid leakage from the puncture site - Monitor FHR for tachycardia or bradycardia Monitoring of the indirect Coombs test to measure the amount of antibodies in the maternal blood. SURGICAL MANAGEMENT: Assist with labor induction if indicated from the 34th to 38th week of gestation - During labor, monitor the fetus electronically and obtain capillary blood scalp sampling to determine acid-base balance - An indication of fetal distress necessities immediate cesarean delivery PHARMACOLOGIC MANAGEMENT: Administer RhoGAM as ordered to Rh-negative patients at 28 weeks gestation and within 72 hours after delivery PSYCHOLOGIC MANAGEMENT: Provide emotional support to the mother and family, encouraging them to express their fears concerning possible complications of treatment

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