1. Rheusus iso-Immunization L2
. Management of sensitized Rh-ve pregnant :
The aim of the management is to : detect the fetal affection earlier and detect its severity ( mild , moderate , severe anemia ) , it deal with it either by intrauterine therapy , or postnatally and timing the delivery to reduce fetal mortality and morbidity .

2. Management
1. Mildly affected fetus : we do the following : maternal plasmaphoresis , early preterm delivery (≥ 34 wks ) + intensive neonatal care ( photo therapy ,etc
2. Moderate to sever affection managed in a specialized center need follow up closely :
A- If gestational age > 34 wks : ( mature lung ) by ( L/S ratio ) delivery and neonatal care ( investigation , exchange transfusion , especially if the Hb% is low ( < = 5g/dl ) .
B- If GA < 34 wks gestation : especially if there is a history of previous severely affected pregnancy ( hydrops or IUD , stillbirth … etc ) intrauterine management and close follow up

3. Follow up 1. a non invasive methods :
A- high resolution U/S : Sonographic finding predicting sever anemia and preceeding hydrops fetalis :
1. Increase amniotic fluid index .
2. Increase liver and spleen ( length and thickness
3. Increase placental thickness ( oedematous )
4. Increase bowel echogenicity .
5. Increase cardiac biventricular diameter .
B- Doppler study of fetal middle cerebral artery&CTG

4. Follow up 2- Invasive methods : 1. Amniotic fluid spectrophotometry
- The result is potted on a spectrophotometric * The Queenan chart ( curve )
*graph called ( Liley graph )
2- Cordocentesis

5. Liley chart

6. Management
Transfusion in Rh iso- immunization ( either intra or extra-uterine )
Is life live saving in a severely anaemic fetus that is too premature for delivery to be contemplated.The aim is to restore Hb levels ,reversing or preventing hydrops or death.It will suppress fetal erythropoesis

7. Blood transfusion
: fresh group O , Rh-ve densely packed red blood cells (Hb around 30 g/L), CMV-ve , washed , compatible to mother blood , irradiated blood ( to decrease the risk of graft versus host disease ) .

8. Routes A- Fetal intraperitoneal : B- Intravascular transfusion :
needle inserted into the umbilical vein at the point of the cord insertion or intrahepatic vein or into the fetal heart .

9. Other methods of Management :
Maternal plasmaphoresis
Phenobarbital

10. New techniques for evaluation fetal Rh status
Amnicocentesis : To test fetal blood types in cases of a heterozygous paternal genotype ( by polymerase chain reaction test )
Fetal blood type by chorionic villous sampling
Flow cytometry

11. Mode of Delivery :
* If intervention is indicated > 35 wks gestation induction of labour ( if no contraindication for obstetric cause ) .
* If < 32 wks C/S .
* There is a low threshold for C/S
All babies born to Rhesus –ve women should have cord blood taken at delivery for a blood count , blood group &indirect Coomb,s test .