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If mother is Rh-negative and father is Rh-positive then administer RhoGAM
95%
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If mother is Rh-negative and father is Rh-negative then administer RhoGAM
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If mother is Rh-positive and father is Rh-negative then administer RhoGAM
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If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed
After 28 weeks gestation, administration of RhoGAM will have no benefit
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A blood test to determine blood type (and Rh status) is necessary for a pregnant woman presenting with vaginal bleeding. If the mother is found to be Rh-negative and the father is either Rh-positive or Rh-unknown, then RhoGAM should be administered. The only exception to administration of RhoGAM for an Rh-negative mother is, if the father is known to be Rh-negative as well, then RhoGAM administration is not required. When an Rh-negative mother carries an Rh-positive fetus, the mother can generate IgG anti-RH antibodies during exposure at delivery or with other pregnancy complications that involve cross-exposure between maternal and fetal blood. In the subsequent pregnancy, an Rh-sensitized mother will produce antibodies that can cross the placenta and cause hemolysis in an Rh-positive fetus. Zolotor et al. discuss prenatal care. Administration of the immune globulin Rho(D) decreases the risk of alloimmunization in Rh-negative women carrying an Rh-positive fetus. If no RhoGAM immunoglobulin is given, the overall risk for becoming alloimmunized is 15%. Administration of Rho(D) at 28 weeks reduces this risk to 0.2%. If only given within 72 hours of delivery, the risk of alloimmunization decreases to 2.0%. Fung Kee Fung et al. review the prevention of Rh alloimmunization in pregnant patients. Three hundred mcg of anti-D immunoglobulin should routinely be given to Rh-negative unsensitized women at 28 weeks when the fetal blood type is either unknown or known to be Rh-positive. At their initial pregnancy visit, all patients should receive an indirect antiglobulin test to screen for the presence of alloantibodies. Illustration A summarizes Rh alloimmunization and the complications that may result in subsequent pregnancies. Incorrect Answers: Answer 2: Both an Rh-negative mother and father cannot produce an Rh-positive fetus; therefore, RhoGAM administration is not necessary. Answer 3: An Rh-positive mother does not require RhoGAM administration. Answer 4: RhoGAM administration is required for cases with an Rh-negative mother and an Rh-positive father. Answer 5: Although it is more effective at 28 weeks gestation, RhoGAM remains effective at reducing the risk of Rh-sensitization all the way through within 72 hours of delivery.
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