Rh incompatibility is a condition that occurs during pregnancy if a woman hasRh-negative blood and her baby has Rh-positive blood. "Rh-negative" and "Rh-positive" refer to whether your blood has Rh factor. Rh factor is a protein on red blood cells. If you have Rh factor, you're Rh-positive. If you don't have it, you're Rh-negative. Rh factor is inherited (passed from parents to children through the genes). Most people are Rh-positive. Whether you have Rh factor doesn't affect your general health. However, it can cause problems during pregnancy.

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Health Topics
Rh negative disease
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2. Overview
Rh incompatibility is a condition that occurs during
pregnancy if
a woman hasRh-negative blood and
her baby has Rh-positive blood.
"Rh-negative" and "Rh-positive" refer to
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3. Overview
whether your blood has Rh factor. Rh factor is a
protein on red blood cells. If
you have Rh factor, you're Rh-positive. If you don't
have it, you're
Rh-negative. Rh factor is inherited (passed from
parents to children through
the genes). Most people are Rh-positive.
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4. Overview
Whether you have Rh factor doesn't affect your
general health.
However, it can cause problems during pregnancy.
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5. Causes
A difference in blood type between a pregnant
woman and her baby
causes Rh incompatibility. The condition occurs if a
woman is Rh-negative and
her baby is Rh-positive.
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6. Causes
When you're pregnant, blood from your baby can
cross into your
bloodstream, especially during delivery. If you're
Rh-negative and your baby is
Rh-positive, your body will react to the baby's
blood as a foreign substance.
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7. Causes
Your body will create antibodies (proteins) against
the baby's
Rh-positive blood. These antibodies can cross the
placenta and attack the
baby's red blood cells. This can lead to hemolytic
anemia in the baby.
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8. Causes
Rh incompatibility usually doesn't cause problems
during a first
pregnancy. The baby often is born before many of
the antibodies develop.
However, once you've formed Rh antibodies, they
remain in your
body. Thus, the condition is more likely to cause
problems in second or later
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9. Causes
pregnancies (if the baby is Rh-positive).
With each pregnancy, your body continues to
make Rh antibodies. As
a result, each Rh-positive baby you conceive
becomes more at risk for serious
problems, such as severe hemolytic anemia.
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10. Risks
An Rh-negative woman who conceives a child
with an Rh-positive man is at risk for
Rh incompatibility.
Rh factor is inherited (passed from parents
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11. Risks
to children through the genes). If you're Rh-
negative and the father of your
baby is Rh-positive, the baby has a50 percent or
more chance of having
Rh-positive blood.
Simple blood tests can
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12. Risks
show whether you and the father of your baby
areRh-positive or
Rh-negative.
If you're Rh-negative, your risk of
problems from Rh incompatibility is higher if you
were exposed to Rh-positive blood
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13. Risks
before the pregnancy. This may have happened
during:
-- An earlier pregnancy (usually during
delivery). You also may have been exposed to Rh-
positive blood if you had
bleeding or abdominal trauma (for example, from
a car accident) during the
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14. Risks
pregnancy.
-- An ectopic pregnancy, a miscarriage, or an
induced abortion. (An ectopic pregnancy is a
pregnancy that starts outside of
the uterus, or womb.)
-- A mismatched blood
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15. Risks
transfusion or blood and
marrow stem cell transplant.
-- An injection or puncture with a needle or
other object containing Rh-positive blood.
Certain tests also can expose you to
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16. Risks
Rh-positive blood. Examples include amniocentesis
(AM-ne-o-sen-TE-sis) and
chorionic villus (ko-re-ON-ik VIL-us) sampling (CVS).
Amniocentesis is a test that you may have
during pregnancy. Your doctor uses a needle to
remove a small amount of fluid
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17. Risks
from the sac around your baby. The fluid is then
tested for various reasons.
CVS also may be done during pregnancy. For
this test, your doctor threads a thin tube through
the vagina and cervix to the
placenta. He or she removes a tissue sample from
the placenta using gentle
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18. Risks
suction. The tissue sample is tested for various
reasons.
Unless you were treated with the medicine
that prevents Rh antibodies (Rh immune globulin)
after each of these events,
you're at risk for Rh incompatibility during current
and future pregnancies.
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19. Symptoms
Rh incompatibility doesn't cause signs or
symptoms in a pregnant woman. In a baby, the
condition can lead to hemolytic
anemia. Hemolytic anemia is a condition in which
red blood cells are
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20. Symptoms
destroyed faster than the body can replace them.
Red blood cells contain hemoglobin
(HEE-muh-glow-bin), an iron-rich protein that
carries oxygen to the body.
Without enough red blood cells and
hemoglobin, the baby won't get enough
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21. Symptoms
oxygen.
Hemolytic anemia can cause mild to severe
signs and symptoms in a newborn, such as
jaundice and a buildup of fluid.
Jaundice is a yellowish color of the skin
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22. Symptoms
and whites of the eyes. When red blood cells
die, they release hemoglobin into
the blood. The hemoglobin is broken down into a
compound called bilirubin. This
compound gives the skin and eyes a yellowish
color. High levels of bilirubin
can lead to brain damage in the baby.
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23. Symptoms
The buildup of fluid is a result of heart failure.
Without enough hemoglobin-carrying red blood
cells, the baby's heart has to
work harder to move oxygen-rich blood through
the body. This stress can lead to
heart failure.
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24. Symptoms
Heart failure can cause fluid to build up
in many parts of the body. When this occurs in a
fetus or newborn, the
condition is called hydrops fetalis (HI-drops fe-TAL-
is).
Severe hemolytic anemia can be fatal to a
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25. Symptoms
newborn at the time of birth or shortly after.
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26. Diagnosis
If you're pregnant, your doctor will order
a simple blood test at your first prenatal visit to
learn whether you're
Rh-positive or Rh-negative.
If you're Rh-negative, you also may have
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27. Diagnosis
another blood test called an antibody screen. This
test shows whether you have
Rh antibodies in your blood. If you do, it means
that you were exposed to
Rh-positive blood before and you're at risk for Rh
incompatibility.
If you're Rh-negative and you don't have Rh
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28. Diagnosis
antibodies, your baby's father also will be tested to
find out his Rh type. If
he's Rh-negative too, the baby has no chance of
having Rh-positive blood. Thus,
there's no risk of Rh incompatibility.
However, if the baby's father is
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29. Diagnosis
Rh-positive, the baby has a 50 percent or more
chance of having Rh-positive
blood. As a result, you're at high risk of developing
Rh incompatibility.
If your baby's father is Rh-positive, or if
it's not possible to find out his Rh status, your
doctor may do a test called
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30. Diagnosis
amniocentesis.
For this test, your doctor inserts a hollow
needle through your abdominal wall into your
uterus. He or she removes a small
amount of fluid from the sac around the baby. The
fluid is tested to learn whether
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31. Diagnosis
the baby is Rh-positive. (Rarely, an amniocentesis
can expose you to
Rh-positive blood).
Your doctor also may use this test to
measure bilirubin levels in your baby. Bilirubin
builds up as a result of red
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32. Diagnosis
blood cells dying too quickly. The higher the level
of bilirubin is, the
greater the chance that the baby has hemolytic
anemia.
If Rh incompatibility is known or
suspected, you'll be tested for Rh antibodies one
or more times during your
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33. Diagnosis
pregnancy. This test often is done at least once at
your sixth or seventh month
of pregnancy.
The results from this test also can suggest
how severe the baby's hemolytic anemia has
become. Higher levels of antibodies
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34. Diagnosis
suggest more severe hemolytic anemia.
To check your baby for hemolytic anemia,
your doctor also may use a test called Doppler
ultrasound. He or she will use
this test to measure how fast blood is flowing
through an artery in the baby's
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35. Diagnosis
head.
Doppler ultrasound uses sound waves to
measure how fast blood is moving. The faster the
blood flow is, the greater the
risk of hemolytic anemia. This is because the
anemia will cause the baby's
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36. Diagnosis
heart to pump more blood.
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37. Treatment
Rh incompatibility is treated with a
medicine called Rh immune globulin. Treatment
for a baby who has hemolytic
anemia will vary based on the severity of the
condition.
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38. Treatment
**Goals of Treatment**
The goals of treating Rh incompatibility
are to ensure that your baby is healthy and to
lower your risk for the
condition in future pregnancies.
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39. Treatment
**Treatment for Rh Incompatibility**
If Rh incompatibility is diagnosed during
your pregnancy, you'll receive Rh immune globulin
in your seventh month of
pregnancy and again within 72 hours of delivery.
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40. Treatment
**Treatment for Rh Incompatibility**
You also may receive Rh immune globulin if
the risk of blood transfer between you and the
baby is high (for example, if
you've had a miscarriage, ectopic pregnancy, or
bleeding during pregnancy).
Rh immune globulin contains Rh antibodies
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41. Treatment
**Treatment for Rh Incompatibility**
that attach to the Rh-positive blood cells in your
blood. When this happens,
your body doesn't react to the baby's Rh-positive
cells as a foreign substance.
As a result, your body doesn't make Rh antibodies.
Rh immune globulin must be
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42. Treatment
**Treatment for Rh Incompatibility**
given at the correct times to work properly.
Once you have formed Rh antibodies, the
medicine will no longer help. That's why a woman
who has Rh-negative blood must
be treated with the medicine with each pregnancy
or any other event that allows
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43. Treatment
**Treatment for Rh Incompatibility**
her blood to mix with Rh-positive blood.
Rh immune globulin is injected into the
muscle of your arm or buttock. Side effects may
include soreness at the
injection site and a slight fever. The medicine also
may be injected into a
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44. Treatment
**Treatment for Rh Incompatibility**
vein.
**Treatment for Hemolytic Anemia**
Several options are available for treating
hemolytic anemia in a baby. In mild cases, no
treatment may be needed. If
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45. Treatment
**Treatment for Rh Incompatibility**
treatment is needed, the baby may be given a
medicine called erythropoietin and
iron supplements. These treatments can prompt
the body to make red blood cells.
If the hemolytic anemia is severe, the baby
may get a blood
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46. Treatment
**Treatment for Rh Incompatibility**
transfusion through the umbilical cord. If the
hemolytic anemia is
severe and the baby is almost full-term, your
doctor may induce labor early.
This allows the baby's doctor to begin treatment
right away.
A newborn who has severe anemia may be
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47. Treatment
**Treatment for Rh Incompatibility**
treated with a blood exchange transfusion. The
procedure involves slowly
removing the newborn's blood and replacing it
with fresh blood or plasma from a
donor.
Newborns also may be treated with special
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48. Treatment
**Treatment for Rh Incompatibility**
lights to reduce the amount of bilirubin in their
blood. These babies may have
jaundice (a yellowish color of the skin and whites
of the eyes). High levels of
bilirubin cause jaundice.
Reducing the blood's bilirubin level is
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49. Treatment
**Treatment for Rh Incompatibility**
important because high levels of this compound
can cause brain damage. High
levels of bilirubin often are seen in babies who
have hemolytic anemia. This is
because the compound forms when red blood cells
break down.
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50. Living and coping
If you have Rh-negative blood, injections
of Rh immune globulin can reduce your risk of Rh
incompatibility in future
pregnancies. It's important to get this medicine
every time you give birth to
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51. Living and coping
an Rh-positive baby or come in contact with Rh-
positive blood.
If you're Rh-negative, your risk of
problems from Rh incompatibility is higher if you
were exposed to Rh-positive
blood before your current pregnancy. This may
have happened during:
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52. Living and coping
-- An earlier pregnancy (usually during
delivery). You also may have been exposed to Rh-
positive blood if you had
bleeding or abdominal trauma (for example, from
a car accident) during the
pregnancy.
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53. Living and coping
-- An ectopic pregnancy, a miscarriage, or an
induced abortion. (An ectopic pregnancy is a
pregnancy that starts outside of
the uterus, or womb.)
-- A mismatched blood
transfusion or blood and marrow
52

54. Living and coping
stem cell transplant.
-- An injection or puncture with a needle or
other object containing Rh-positive blood.
You also can be exposed to Rh-positive
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55. Living and coping
blood during certain tests, such as amniocentesis
and chorionic villus
sampling. (For more information, go to "Who
Is At Risk for Rh Incompatibility?")
Unless you were treated with Rh immune
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56. Living and coping
globulin after each of these events, you're at risk
for Rh incompatibility
during current and future pregnancies.
Let your doctor know about your risk early
in your pregnancy. This allows him or her to
carefully monitor your pregnancy
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57. Living and coping
and promptly treat any problems that arise.
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