Sensitization usually does not harm the first Rh-positive baby but endangers subsequent Rh-positive pregnancies.
Before you read
Test yourself first: 1 question
Question 1 of 1
An Rh-negative client at 28 weeks gestation with a negative antibody screen is scheduled to receive Rho(D) immune globulin (RhoGAM). Which statement by the nurse correctly explains its purpose?
Answer: A. Rho(D) immune globulin prevents maternal sensitization by destroying any fetal Rh-positive red cells in the maternal circulation before the mother forms antibodies. It is given routinely at about 28 weeks and again within 72 hours after delivery of an Rh-positive infant. It does not treat existing antibodies and is not for the fetus's anemia.
Keep the streak going with more questions like these, each with a full rationale.
What is rh incompatibility and rhogam?
In a later pregnancy these antibodies attack Rh-positive fetal red cells, causing hemolytic disease. RhoGAM (Rh immune globulin) prevents this sensitization.
Key points to remember
- Sensitization usually does not harm the first Rh-positive baby but endangers subsequent Rh-positive pregnancies.
- RhoGAM is given to Rh-negative, antibody-negative mothers at about 28 weeks gestation and within 72 hours after delivery of an Rh-positive infant.
- RhoGAM is also indicated after any event that mixes blood: miscarriage, abortion, ectopic pregnancy, amniocentesis, CVS, or abdominal trauma.
- An indirect Coombs test on the mother detects existing anti-Rh antibodies; a positive result means she is already sensitized and RhoGAM will not help.
- A direct Coombs test on cord blood detects antibodies already attached to fetal red cells.
Nursing priorities
- Verify maternal blood type, Rh status, and antibody screen during prenatal care.
- Administer RhoGAM IM (typically in the deltoid or ventrogluteal site) at 28 weeks and after qualifying events.
- After delivery, confirm the infant is Rh-positive before giving the postpartum dose.
- Document administration and educate the mother that the protection applies only to the current exposure.
Labs & values
Patient teaching
- RhoGAM protects future pregnancies; you will need a new dose with each pregnancy and after any bleeding event.
- Carry a record of your blood type and Rh status, and inform every provider that you are Rh negative.
Red flags: report now
- RhoGAM is ineffective and not given if the mother is already sensitized (positive indirect Coombs).
- Missing the 72-hour postpartum window leaves the mother at risk of sensitization for future pregnancies.
- Signs of fetal hemolytic disease (erythroblastosis fetalis) such as hydrops or severe jaundice require urgent intervention.
References
Clinical references for this topic
