Rh Disease

What is Rh disease?

Rh disease occurs during pregnancy. It happens when the Rh factors in the mom’s and baby’s blood don’t match. It may also happen if the mom and baby have different blood types.  

What causes Rh disease?

Each person has a blood type (O, A, B, or AB). Everyone also has an Rh factor (positive or negative).

The Rh factor is a protein on the covering of the red blood cells. If the Rh factor protein is on the cells, the person is Rh positive. If there’s no Rh factor protein, the person is Rh negative.

A baby may have the blood type and Rh factor of either parent, or a combination of both parents.

There can be a problem when an Rh negative mother has a baby with an Rh positive father. If the baby's Rh factor is positive, like his or her father's, this can be an issue if the baby's red blood cells cross to the Rh negative mother. When this happens, the mom becomes sensitized to Rh positive blood.

This often happens at birth when the placenta breaks away. But it may also happen any time the mom’s and baby's blood cells mix. This can occur during a miscarriage or fall. It may also happen during a prenatal test. These can include amniocentesis or chorionic villus sampling. These tests use a needle to take a sample of tissue. They may cause bleeding.

The Rh negative mom’s immune system sees the baby's Rh positive red blood cells as foreign. Your immune system responds by making antibodies to fight and destroy these foreign cells. Your immune system stores these antibodies in case these foreign cells come back again. This can happen in a future pregnancy. You are now Rh sensitized.

Rh sensitization normally isn’t a problem with a first pregnancy. Most issues occur in future pregnancies with another Rh positive baby. During that pregnancy, your antibodies cross the placenta to fight the Rh positive cells in your baby's body. As the antibodies destroy the cells, your baby gets sick. Your baby could have jaundice, heart failure, and enlarged organs.

Who is at risk for Rh disease?

Women who are Rh negative and are pregnant with a baby whose father is Rh positive are at risk for this condition. Your risk is much higher if you’ve been pregnant before. There is normally no risk for Rh disease during a first pregnancy, unless you’ve been sensitized before pregnancy. 

What are the symptoms of Rh disease?

A mother has no signs of Rh disease. But your baby can have problems if you develop antibodies.

Symptoms can occur a bit differently in each pregnancy and child. During pregnancy, symptoms may include:

• A yellow coloring of amniotic fluid. This color may be because of bilirubin. This is a substance that forms as blood cells break down.
• Your baby may have a big liver, spleen, or heart. There may also be extra fluid in his or her stomach, lungs, or scalp. These are signs of hydrops fetalis. This condition causes severe swelling (edema).

Rh disease can cause problems in your newborn. The condition caused by Rh disease in babies is called hemolytic disease of the newborn (HDN). Your baby may have the following symptoms:

• Yellow coloring of the skin and whites of the eyes (jaundice)
• Pale-coloring because of anemia
• Fast heart rate (tachycardia)
• Fast breathing (tachypnea)
• Lack of energy
• Swelling under the skin
• Large abdomen

The symptoms of Rh disease may look like symptoms of other conditions. See your healthcare provider for a diagnosis.

How is Rh disease diagnosed?

Your healthcare provider may suspect Rh disease if you had an Rh positive baby in a past pregnancy. Your healthcare provider will ask you about your health history. He or she will also give you an exam.

You may need the following tests to check for Rh disease:

• Testing for Rh positive antibodies in your blood.
• Ultrasound. This test can show enlarged organs or fluid buildup in your baby.
• Amniocentesis. This test checks the amount of bilirubin in the amniotic fluid. In this test, a needle is inserted into your abdominal and uterine wall. It goes through to the amniotic sac. The needle takes a sample of amniotic fluid.
• Percutaneous umbilical cord blood sampling or fetal blood sampling. In this test, a blood sample is taken from your baby’s umbilical cord. Your child’s healthcare provider will check this blood for antibodies, bilirubin, and anemia.

How is Rh disease treated?

Treatment will depend on your pregnancy and general health. It will also depend on how severe the condition is.

Intrauterine blood transfusion

This test puts red blood cells into your baby's circulation. In this test, a needle is placed through your uterus. It goes into your baby’s abdominal cavity to a vein in the umbilical cord. Your baby may need sedative medicine to keep him or her from moving. You may need to have more than one transfusion.

Early delivery

If your baby gets certain complications, he or she may need to be born early. Your healthcare provider may induce labor once your baby has mature lungs.

What are the complications of RH disease?

Complications from Rh disease in your baby may include:

• Anemia. In some cases, anemia is severe. Your baby’s spleen and liver may be enlarged.  
• Jaundice
• Hydrops fetalis. This happens when your baby's organs aren’t able to handle the anemia. Your baby’s heart will start to fail. This will cause large amounts of fluid buildup in your baby's tissues and organs. Babies with this condition are at risk for being stillborn.

After birth, your baby may have the following:

• Severe jaundice. Your baby’s liver can’t handle the large amount of bilirubin. This causes your baby’s liver to grow too big. He or she will still have anemia.
• Kernicterus. The most severe form of too much bilirubin. It’s due to the buildup of bilirubin in your baby’s brain. This can cause seizures, brain damage, and deafness. It can even cause death.

Can Rh disease be prevented?

Rh disease can be prevented. Almost all women will have a blood test to learn their blood type early in pregnancy.

If you’re Rh negative and have not been sensitized, you’ll get a medicine called Rh immunoglobulin (RhoGAM). This medicine can stop your antibodies from reacting to your baby’s Rh positive cells. You’ll get RhoGAM around week 28 of pregnancy. You may get it earlier if you have vaginal bleeding, trauma, or amniocentesis before 28 weeks.

If your baby is Rh positive, you’ll get a second dose of medicine within 72 hours of giving birth. If your baby is Rh negative, you won’t need a second dose.

When should I call my healthcare provider?

Call your healthcare provider if you’re Rh negative and have vaginal bleeding or trauma during your pregnancy. Your healthcare provider may give you RhoGAM.

Key points about Rh disease

• Rh disease occurs during pregnancy. It happens when the Rh factors in the mom’s and baby’s blood don’t match.
• If the Rh negative mother has been sensitized to Rh positive blood, her immune system will make antibodies to attack her baby.
• When the antibodies enter your baby's bloodstream, they will attack the red blood cells. This causes them to break down. This can lead to problems.
• This condition can be prevented. Women who are Rh negative and haven’t been sensitized can receive medicine. This medicine can stop your antibodies from reacting to your baby’s Rh positive cells.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.