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

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 their father’s, it can be an issue if the baby’s red blood cells cross
the Rh negative mother. When that happens, the mom becomes sensitized to Rh positive

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. It can occur during a miscarriage or fall. It may also happen during a
prenatal test. These can include amniocentesis or chorionic villus sampling. These
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
making antibodies to fight and destroy these foreign cells. Your immune system stores
these antibodies in case these foreign cells come back again. It 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.

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. 

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

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 is released when blood cells break down.
  • Your baby may have a big liver,
    spleen, or heart. There may also be extra fluid in your baby’s stomach, lungs, or
    scalp. These are signs of hydrops fetalis. This condition causes severe swelling

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.

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. Your provider will also give you

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

  • Blood tests. These check 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.

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 from moving. You may need to have more than one

Early delivery

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

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 condition
    happens when your baby’s organs aren’t able to handle the anemia. Your baby’s heart
    will start to fail. That 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. So your baby’s liver grows too big. Your
    baby will still have anemia.
  • Kernicterus. This condition is the
    most severe form of too much bilirubin. It’s due to the buildup of bilirubin in your
    baby’s brain. It can cause seizures, brain damage, and deafness. It can even cause

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.

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.

  • 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, causing 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.

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
  • 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
  • Know how you can contact your provider if you have questions.