Rh incompatibility

He kūpono ʻole ʻo Rh incompatibility ke hoʻomohala i ka wā he wahine Rh-maikaʻi ʻole ka wahine hāpai a ʻo ke pēpē i loko o kāna ʻōpū he koko Rh-maikaʻi.

I ka wā o ka hāpai ʻana, hiki i nā hunaola ʻulaʻula mai ka pēpē hānau ʻole ke hele i loko o ke koko o ka makuahine ma o ka placenta.

Inā Rh-maikaʻi ʻole ka makuahine, mālama ʻo ia i kāna ʻōnaehana pale pale Rh-positive fetal cells me he mea lā he haole. Hana ke kino o ka makuahine i nā mea pale kūʻē i nā hunaola koko fetal. Hiki ke hele i hope kēia mau mea ʻino ma o ka placenta i loko o ka pēpē e ulu ana. Hoʻopau lākou i nā hunaola ʻulaʻula o ke pēpē o ka pēpē.

Ke wāwahi ʻia nā hunaola ʻulaʻula, hana lākou i bilirubin. ʻO kēia ke kumu e lilo ai ke pēpē i melemele (kuʻi ʻia). ʻO ke kiʻekiʻe o ka bilirubin i ke koko o ke pēpē mai ke ʻano haʻahaʻa a i ke kiʻekiʻe weliweli.

ʻAʻole pili pinepine nā pēpē hānau mua ke ʻole nā ​​hānau hānau i hala a i ʻole nā ​​hāpai ʻana o ka makuahine. Hoʻomaopopo kēia i kāna ʻōnaehana pale. ʻO kēia no ka mea he manawa ka manawa no ka makuahine e hoʻomohala i nā mea pale. ʻO nā keiki āpau āna i loaʻa ma hope ʻo Rh-positive paha e loli ʻia.

Hoʻolālā wale ʻo Rh incompatibility ke Rh-maikaʻi ʻole ka makuahine a Rh-maikaʻi ka pēpē. Ua lilo kēia pilikia i mea liʻiliʻi ma nā wahi e hāʻawi i ka mālama prenatal maikaʻi. ʻO kēia no ka mea hoʻohana maʻamau nā globulins immune kūikawā i kapa ʻia ʻo RhoGAM.

Hiki i ka Rh incompatibility ke kumu i nā ʻōuli mai ke akahai a i ka make. Ma kona ʻano akahai, Rh incompatibility ke kumu o ka luku ʻia ʻana o nā hunaola ʻulaʻula. ʻAʻohe hopena ʻē aʻe.

Ma hope o ka hānau ʻana, loaʻa paha i ke pēpē:

• Melemele o ka ʻili a keʻokeʻo o nā maka (jaundice)
• ʻO ke kani haʻahaʻa (hyponia) a me ka lethargy

Ma mua o ka hānau ʻana, loaʻa paha i ka makuahine ka wai amniotic hou a puni kāna pēpē i hānau ʻole ʻia (polyhydramnios).

Aia paha:

• ʻO kahi hopena hōʻike Coombs pololei pololei
• ʻO nā kiʻekiʻe kiʻekiʻe ma mua o ka maʻamau o ka bilirubin i ke koko umbilical pēpē o ka pēpē
• Nā hōʻailona o ka luku ʻana o ke koko ʻulaʻula i ke koko o ke pēpē

Hiki ke pale ʻia ʻo Rh incompatibility me ka hoʻohana ʻana o RhoGAM. No laila, ʻo ke kāohi ka lapaʻau maikaʻi loa. ʻO ka mālama ʻana i kahi pēpē i hoʻopili ʻia e pili ana i ka paʻakikī o ke ʻano.

Hiki ke mālama ʻia nā kamaliʻi me ka launa ʻole Rh me ka phototherapy e hoʻohana ana i nā kukui bilirubin. Hiki ke hoʻohana pū ʻia ʻo IV immune globulin. No nā pēpē e loli loa, pono ʻia kahi transfusion o ke koko. ʻO kēia ka mea e hōʻemi i nā pae o ka bilirubin i ke koko.

Kuhi ʻia ka hoʻōla piha no ka launa ʻole Rh māmā.

Komo pū nā pilikia:

• Hoʻopilikia ka lolo ma muli o ke kiʻekiʻe o ka bilirubin (kernicterus)
• ʻO ka hoʻonui ʻana o ka wai a me ka pehu ʻana i ka pēpē (hydrops fetalis)
• Nā pilikia me ka hana noʻonoʻo, ka neʻe, ka hoʻolohe, ka ʻōlelo, a me ka hopu ʻana

Kāhea i kāu mea mālama ola inā manaʻo ʻoe a ʻike paha he hāpai ʻoe a ʻaʻole ʻoe i ʻike i kahi mea hāʻawi.

Rh aneane hiki ke pale ʻia. Pono e ukali kokoke ʻia nā makuahine Rh-maikaʻi ʻole e kā lākou mea hoʻolako i ka wā hāpai.

Hoʻohana ʻia nā globulins pale ʻole kūikawā, i kapa ʻia ʻo RhoGAM, i kēia manawa e pale aku i ka launa ʻole RH i nā makuahine Rh-maikaʻi ʻole.

Inā Rh-maikaʻi ka makuakāne o ke pēpē a i ʻole ʻaʻole ʻike ʻia kona ʻano koko, hāʻawi ʻia ka makuahine i kahi ʻoki o RhoGAM i ka manawa o ka trimester ʻelua. Inā Rh-maikaʻi ka pēpē, e loaʻa ka makuahine i ka lua o ka ʻoki i loko o kekahi mau lā ma hope o ka hānau ʻana.

Pale aku kēia mau injection i ka hoʻomohala ʻana o nā mea pale e kūʻē i ke koko Rh-maikaʻi. Eia nō naʻe, pono i nā wahine me ke ʻano Rh-maikaʻi ʻole ke loaʻa nā injection.

• I kēlā me kēia hāpai
• Ma hope o ka hāpai keiki ʻole a hāpai keiki paha
• Ma hope o nā hōʻike prenatal e like me amniocentesis a me chopionic villus biopsy
• Ma hope o ka hōʻeha i ka ʻōpū i ka wā hāpai

ʻO ka maʻi hemolytic Rh-i hoʻokomo ʻia o ka hānau hou; Erythroblastosis fetalis

• Jaundice hānau hou - hoʻokuʻu

• Erythroblastosis fetalis - kiʻi kiʻi kiʻi
• Pēpē Jaundiced
• Nā Antibodies
• Exchange transfusion - moʻo
• Rh incompatibility - moʻo

ʻO Kaplan M, Wong RJ, Sibley E, Stevenson DK. ʻO ka jaundice neonatal a me nā maʻi ate. I: Martin RJ, Fanaroff AA, Walsh MC, hua. ʻO Fanaroff lāua ʻo Martin's Neonatal-Perinatal Medicine. 10 o ka lā. Piladelapia, PA: Elsevier Saunders; 2015: chap 100.

ʻO Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Nā maʻi koko. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 124.

Moise KJ. Alloimmunization pūnaewele ʻula. I: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Nā Obstetrics: Nā Pregnancies Maʻamau a me nā pilikia. ʻEpekema 7 Piladelapia, PA: Elsevier; 2017: chap 34.