Hemolytic disease of the newborn - Diagnosis and disease monitoring Rh incompatibility hemolytic by

Diagnosis is suggested by the presence of antibodies in serum free pregnant woman whose husband esteRh Rh positive.
It follows the extent of hemolysis and fetal condition by:- History: preconceptuale transfusions, evolution sarcinilorprecedente (voluntary or spontaneous abortions, ectopic pregnancies, stillbirths, live births with hemolytic disease), obstetrical maneuvers in the first months of the current pregnancy (trophoblastic puncture, early amniocentesis);- Dosage series of free antibody in serum (2-3 weeks) pursuing the critical threshold beyond which the risk of fetal death intruterina.This critical threshold of 1 / 16 (rated by Coombs test);- Determination of bilirubin in the amniotic fluid (biliamnia) by spectrophotometric methods and reporting optical index (I.O450) age Liley load diagram which delineates three areas of gravity: the one - the fetus is not easily affected or damaged, the 2 - the fetus can be affected by levels of hemoglobin at birth between 13.9 and 8g/100, Zone 3 - the fetus is severely affected in the CMEA, the imminent intrauterine death.Interpretation of IO450 value should be approached cautiously because there are false negative (dilution hidramnios) or false positive (concentration in amniotic fluid oligoamnios or contamination with fetal blood or brown).
Biliamniei level is suggestive of so much as it decreases normally with advancing pregnancy;- Determination of fetal hemoglobin by cordocentesis perform specialized teams and usually is correlated with fat interventions (transfusions or intrauterine transfusion exsanghino-). It is indicated in cases of severe obstetric history (intrauterine death, severe hemolytic b. in normal fetal ultrasound imuniyari and important).- Monitoring the state of fetal ultrasound obstetrical velocometrie Doppler and fetal heart rate monitor (RCF)
 Ultrasound is a key test because:- Says age pregnancy, fetal active movements and fetal development intrauerina;- Highlight the early signs of decompensation, ascites oedematous;- Allow guided amniocentesis;- Allows tracking of the peritoneum s'ngelui absorption after intraperitoneal transfusions to the fetus.
 1. Syndrome ultrasound decompensareprecoceFetus shows a large abdomen with intestinal loops abnormally Ecogen with intestinal wall visible, enlarged liver. With moderate excess amniotic fluid.2. Functional anasarcaFetus with subcutaneous edema and ascites. Excess amniotic fluid. Thickened placenta.3. Anasarca lesionalFat with significant subcutaneous edema (double contour) and serous effusions, massive.Amniotic fluid abuldent (hidramnios). Placenta thick with heterogeneous structure.Velocumetria Doopler the descending aorta can highlight the increasing speed of blood flow, correlated with the degree of anemia.Fetal heart rate is estimated by 2-3 entries a day to be taken into account anomalies that may suggest impaired fetus are flat or slightly reactive route, slow the rate of spontaneous or induced contractions (usually associated with severe anemia ), sinus rhythm.