A 25-year-old pregnant woman with Rh incompatibility delivers a baby. What would be the likely complication for the neonate?

1. A

   Delayed cry after birth

2. B

   Hypoglycaemia

3. C

   Respiratory distress

4. D

   Haemolytic anaemia

Appeared in: RML 2023

Explanation

• Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus.
• During pregnancy or birth, fetal RBCs can enter the maternal circulation, causing the mother to produce anti-Rh IgG antibodies.
• In subsequent pregnancies, these maternal antibodies cross the placenta and destroy the fetus's red blood cells (a process called hemolysis).
• This widespread destruction of RBCs is known as haemolytic anaemia, which is the primary and defining complication of Hemolytic Disease of the Newborn (HDFN).

Why Other Options Were Wrong

• Option A: This is a classic sign of birth asphyxia or central nervous system depression, not a direct consequence of red blood cell hemolysis.
• Option B: While it can occur as a secondary issue in severely ill infants with HDFN, it is not the primary complication. It is most characteristically seen in infants of diabetic mothers.
• Option C: This is a complication of very severe, advanced HDFN, a condition known as hydrops fetalis, where massive fluid accumulation impairs lung function. It is not the initial, direct complication.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Rh Incompatibility and Neonatal Complications as background academic context rather than a clinical decision trigger.
• Antenatal screening for blood type and Rh factor is a critical nursing responsibility to identify at-risk pregnancies early.
• Administering Rho(D) immune globulin (e.g., RhoGAM) to Rh-negative mothers at approximately 28 weeks gestation and within 72 hours of delivering an Rh-positive baby is the cornerstone of preventing maternal sensitization.
• Nurses must closely monitor newborns of Rh-incompatible pregnancies for jaundice, pallor, lethargy, and tachycardia, which are key signs of haemolytic anaemia and hyperbilirubinemia.

How to Approach the Question

• First, identify the key clinical concept in the question: 'Rh incompatibility'.
• Recall the basic pathophysiology of this condition: it's an immune reaction where maternal antibodies attack the fetus's or neonate's red blood cells.
• Analyze the term 'haemolytic anaemia'. 'Hemo-' relates to blood, '-lytic' means destruction, and 'anaemia' is a deficiency of red blood cells. This term perfectly describes the core disease process.
• Evaluate the other options. Hypoglycemia, respiratory distress, and delayed cry are all possible neonatal problems, but they are not the direct and primary result of the immune-mediated RBC destruction that defines Rh incompatibility.
• Conclude that the most direct and therefore most likely complication is the one that describes the fundamental pathology of the disease.

Concept Tested & Keywords

• Concept Tested: Rh Incompatibility and Neonatal Complications
• Stem keywords: Rh incompatibility, pregnant woman, neonate, complication
• Lead-in keywords: likely complication
• Clinical cues: The history of Rh incompatibility is the key clinical cue pointing towards an immune-mediated process affecting the baby's blood.

Question ID

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Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 1133-1135, 1134-1136