Incompatibilidad Rh
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
Factores de riesgo
- antecedentes de un feto RhD positivo en una madre RhD negativa
- hemorragia fetomaterna
- procedimientos fetales invasivos
- traumatismo placentario
- aborto
- multiparidad
- omisión de la inmunoprofilaxis Rh
- versión cefálica externa
- embarazo molar
- embarazo ectópico
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- grupo sanguíneo materno
- cribado de anticuerpos Rh séricos maternos
Pruebas diagnósticas que deben considerarse
- título de anticuerpos séricos maternos
- grupo sanguíneo paterno
- cigosis paterna
- ultrasonido fetal
- Velocimetría Doppler de la arteria cerebral media fetal (velocidad sistólica pico)
- determinación del grupo sanguíneo fetal (por amniocentesis o circulación maternal)
- evaluación directa de la anemia fetal
- prueba de rosetas
- prueba de Kleihauer-Betke/citometría de flujo
Algoritmo de tratamiento
madre RhD negativa no sensibilizada
madre RhD negativa sensibilizada
neonato con eritroblastosis
Colaboradores
Autores
Andrew D. Hull, MD, FRCOG, FACOG
Professor of Clinical Obstetrics, Gynecology, and Reproductive Sciences
Director, UC San Diego Maternal-Fetal Care and Genetics
Division of Maternal-Fetal Medicine
Department of Obstetrics, Gynecology, and Reproductive Sciences
University of California San Diego
La Jolla
CA
Divulgaciones
ADH declares that he has no competing interests.
Agradecimientos
Dr Andrew D. Hull would like to gratefully acknowledge Dr Karen Fung-Kee-Fung and Dr Felipe Moretti, previous contributors to this topic.
Divulgaciones
KFKF is an author of a reference cited in this topic. KFKF and FM declare that they have no competing interests.
Revisores por pares
Alan Cameron, MD
Honorary Professor of Medicine
University of Glasgow
Glasgow
UK
Divulgaciones
AC is an author of several references cited in this topic.
Liakat Ali Parapia, MD, FRCP
Consultant Hematologist
Bradford Teaching Hospitals NHS Trust
Yorkshire Clinic
Bingley
Bradford
UK
Divulgaciones
LAP declares that he has no competing interests.
Kenneth J. Moise, Jr., MD
Professor of Obstetrics and Gynecology
Texas Children's Fetal Center
Baylor College of Medicine/Texas Children's Hospital
Houston
TX
Divulgaciones
KJM declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referencias
Artículos principales
American Congress of Obstetrics and Gynecology. ACOG practice bulletin no. 181: prevention of Rh D alloimmunization. Obstet Gynecol. 2017 Aug;130(2):e57-70. Resumen
Fung KFK, Eason E. No. 133: prevention of Rh alloimmunization. J Obstet Gynaecol Can. 2018 Jan;40(1):e1-10. Resumen
Mari G, Deter RL, Carpenter RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med. 2000 Jan 6;342(1):9-14.Texto completo Resumen
Fung Kee Fung K, Eason E, Crane J, et al. Prevention of Rh alloimmunization. J Obstet Gynaecol Can. 2003 Sep;25(9):765-73.Texto completo Resumen
Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20.Texto completo Resumen
American Congress of Obstetrics and Gynecology. ACOG practice bulletin no. 192: management of alloimmunization during pregnancy. Obstet Gynecol. 2018 Mar;131(3):e82-90. Resumen
Qureshi H, Massey E, Kirwan D, et al. BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn. Transfus Med. 2014 Feb;24(1):8-20.Texto completo Resumen
Mari G, Deter RL, Carpenter RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med. 2000 Jan 6;342(1):9-14.Texto completo Resumen
Visser GHA, Thommesen T, Di Renzo GC, et al. FIGO/ICM guidelines for preventing Rhesus disease: a call to action. Int J Gynaecol Obstet. 2021 Feb;152(2):144-7.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Hidropesía fetal no inmune
- Infección por parvovirus
- Enfermedad hemolítica no RhD
Más DiferencialesGuías de práctica clínica
- Ectopic pregnancy and miscarriage: diagnosis and initial management
- Prophylactic use of RhD immunoglobulin in pregnancy care
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