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Rh Incompatibility in Early Medical Abortion, a Misoprostol Case Report

Johanna Loehr, Faidra Marazak, Mara Genovefa

Abstract

Introduction: The Rhesus factor is an erythrocyte surface antigen which is inherited separately from the AB0 system. The trait Rh+ refers to the presence of the surface antigen whereas Rh- implies its absence.

Rhesus incompatibility occurs when an Rh- mother is pregnant with an Rh+ child, leading to formation of Rhesus antibodies in the maternal blood. In 90% of the cases, sensitization occurs during delivery, thus leading to a future second incompatible pregnancy. Other reasons for fetomaternal blood transfusion are trauma, abortion, miscarriage  or invasive methods. In this case report, a medical abortion with misoprostol and Anti D administration at 6 weeks of gestational age of an  Rh minus woman with positive paternal Rhesus status is presented.

Materials and Methods: The patient was a 19-year-old Rhesus negative female patient with positive pregnancy urine test seeking abortion. The paternal Rhesus was positive.

Beta pregnancy test: 2698 mIU/ml and  ultrasound findings reveal presence of gestational sack (6 weeks gestational age). Full blood examination and ECG  were normal. No contraindications for medical abortion were present and the Misoprostol alone regimen was chosen for medical abortion with 8 tablets of Cytotec (misoprostol) sublingually and intravaginally. The patient was not hospitalized. Prophylactic antibiotics (vibramycin) were administered and NSAIDS were recommended for pain management. There was also administration of Rhophylac, IM, within 72 hrs and patient observation for at least 20 minutes following the administration.

Results: One day post misoprostol regimen administration, ultrasound examination  revealed an absence of gestational sack with 11 mm endometrial thickness. This regimen resulted in a complete abortion with no adverse side effects, such as vomiting, diarrhea or abdominal cramps. Follow-up ultrasound, revealed  6.3 millimeters of endometrial thickness.

Conclusion: There is not enough evidence concerning the application of Anti D Serum after medical abortion in Rhesus minus pregnancies before the 12th week of gestation. Further longitudinal studies and consecutive follow-up of treated patients are obligatory for establishing evidence-based  guidelines.


Keywords

medical abortion, Rhesus incompatibility, Anti-D prophylaxis, misoprostol case report


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