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by Alan R

Rh Incompatibility and Isoimmunization

(RhD Incompatibility)


Rh factor is a protein that may be found on the surface of red blood cells. If you carry this protein, your blood is Rh positive. If you don't carry this protein, your blood is Rh negative.
Sometimes a mother with Rh-negative blood is pregnant with a baby that has Rh-positive blood. This can cause a problem if the baby's blood enters the mother's blood flow. The Rh-positive blood from the baby will make the mother's body create antibodies. This is called isoimmunization. The antibodies will attack any Rh-positive blood cells. This will not cause a problem for the mother. However, the antibodies can pass to the developing baby and destroy some of the baby's blood cells.
Fortunately, Rh incompatibility is often prevented with an immunization. If the condition is not prevented, the baby may need care.


A baby's Rh status is determined from the mother and father. If the mother is Rh negative and the father is Rh positive, the baby has at least a 50% chance of being Rh positive. However, Rh isoimmunization will only happen if the baby's Rh-positive blood enters the mother's blood flow. In most pregnancies, the mother's and baby's blood will not mix. The baby's blood may come into contact with the mother's blood flow during:
The mix in blood happens most often at the end of pregnancy. This means it is rarely a problem in a woman's first pregnancy. The mother's antibodies could affect a future pregnancy with a baby with Rh-positive blood even if the blood is not mixed.
A woman can also become sensitized to Rh-positive blood if she receives an incompatible blood transfusion .
Blood Flow to Fetus
Placenta Function
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that put you at risk for Rh incompatibility include being an Rh-negative pregnant woman who:
  • Had a prior pregnancy with a baby that was Rh positive
  • Had a prior blood transfusion or amniocentesis
  • Did not receive Rh immunization prophylaxis during a prior pregnancy with an Rh-positive baby


Symptoms and complications will only affect the baby. The complications occur when standard preventive measures are not taken. The symptoms can vary from mild to severe.
Symptoms that can develop in the baby include:
A complication of untreated jaundice is kernicterus, a syndrome which can affect the baby's nervous system. Contact your doctor right away if your baby:
  • Has a yellow or orange appearance to the skin
  • Does not sleep
  • Is hard to wake up
  • Is not breastfeeding or has difficulty sucking from a bottle
  • Is restless or fussy
Call for emergency medical help if your baby has:
  • High pitched crying or crying that won't stop
  • A bowed body
  • A stiff, limp, or floppy body
  • Strange eye movements


You cannot detect Rh incompatibility on your own. A blood test can determine whether you are Rh positive or Rh negative. The blood test will also look for Rh antibodies or monitor the levels of antibodies through pregnancy. If the antibody levels are high, an amniocentesis can determine if the fetus is ill.
It is important to have a blood test at the beginning of pregnancy.


Rh incompatibility is almost completely preventable using immunization. The best treatment is prevention.
If Rh incompatibility does occur, then the baby may need treatment based on symptoms such as:

Mild Symptoms

Full recovery is expected for mild Rh incompatibility. Treatment may include:
  • Aggressive hydration
  • Phototherapy —light therapy to treat skin conditions

Swelling of the Body (Hydrops fetalis)

More severe condition that may require:
  • Intrauterine fetal transfusion—to replace blood cells that are being destroyed during pregnancy
  • Early induction of labor
  • A direct transfusion of packed red blood cells which are compatible with the infant's blood
  • An exchange transfusion to remove the mother's antibodies
  • Control of heart failure and fluid retention

Kernicterus may be treated with:

  • Exchange transfusion—replacing baby's blood with blood with Rh-negative blood cells
  • Phototherapy
Both hydrops fetalis and kernicterus are more severe conditions. Long-term problems can also develop with severe cases, including:


If a mother is at risk for Rh incompatibility, then an injection of Rho immune globulin will be given at week 28 of the pregnancy. A second injection will be given within 72 hours after delivery. These injections will block the mother's body from developing antibodies. Women at risk may also be given these injections after a miscarriage, induced abortion, or ectopic pregnancy. These injections will protect the current pregnancy and future pregnancies.
Routine prenatal care should help identify, manage, and treat any complications of Rh incompatibility.


American Congress of Obstetricians and Gynecologists
American Pregnancy Association


The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters


Hemolytic disease of the fetus and newborn (HDFN). EBSCO DynaMed Plus website. Available at: . Updated August 15, 2017. Accessed March 8,2 018.
Facts about jaundice and kernicterus. Centers for Disease Control and Prevention website. Available at: Updated November 7, 2016. Accessed March 8, 2018.
Rh factor. American Pregnancy Association website. Available at: Updated March 2, 2017. Accessed March 8, 2018.

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