Rh Isoimmunization Prevention and Cervical Health Screening

Written on January 11, 2026 in English with a size of 7.1 KB

Rh Prophylaxis and Prenatal Rh Screening

Prophylaxis of Rh

NIPT = check the fetal blood, by amniocentesis (positive) Free fetal DNA in mother

Susceptible:

Mom Rh(–) / Father Rh(+) / Genotype: amniocentesis

Mom should be checked W11–13, 20 and 27

If mother is Rh(–), give Rho(D) immune globulin (Rhogam) at 28 weeks and within 72 hours of delivery or an invasive procedure.

Rhogam is an antibody against Rh(D) antigen. It binds fetal Rh(D)+ red cells and masks the antigen from the maternal immune system, preventing maternal sensitization and subsequent immune response.

Rhogam: anti‑RhD antibody.

Risk factor (RF): hemolytic anemia of the fetus.

Cervical Dysplasia and Staging

Cervical dysplasia (Gx): abnormal tissue growth, a precancerous condition which may progress to cancer.

Key features

HPV infection of basal/maturing squamous cells
Koilocytotic atypia on cytology

Major risk factors

HPV (high‑risk strains; commonly 16, 18, 31, 33, 39, etc.)
Early onset of sexual activity
No barrier protection
Smoking

I – CIN 1: Abnormal cells in the lower one‑third of the epithelium (LSIL)

II – CIN 2 (Moderate): Abnormal cells > one‑third up to two‑thirds of the epithelium (HSIL)

III – CIN 3 (Severe / Carcinoma in situ): Abnormal cells involving > two‑thirds of the epithelium (HSIL)

IV – Invasion: Abnormal cells extend deeper than the basal layer: invasive cancer

Pathophysiology

HPV enters the basal layer and replicates in maturing squamous cells —> koilocytotic atypia.

Diagnosis

PAP smear (screen)
Liquid‑based cytology
Immunocytochemical stains
Colposcopy — if abnormal: colposcopy with directed biopsy. If cancer is confirmed, staging is required with CT / MRI.

Treatment

CIN1 — local destruction or excision
CIN2 — excision
CIN3 — excision; hysterectomy if additional pathology or other indications

Cervical Cancer Prevention and Screening

Primary prevention (risk reduction and vaccination)

Safe sex practices
Use of condoms
Limiting number of sexual partners
HPV vaccination

Secondary prevention (screening and early diagnosis/treatment)

Cervical cancer screening: ages 25–60 (screening interval varies by local guideline)

PAP smear procedure:

A — ensure patient privacy
B — insert speculum into vagina
C — use scraper/brush to collect cells from the cervix
Microscopy to evaluate for abnormal cells

HPV DNA testing + colposcopy + biopsy as indicated.

Colposcopy indications: white acetowhite staining with acetic acid; punctate or atypical vessels — abnormal areas require biopsy.

Prenatal Screening and First Visit Testing

Prenatal screening:

First prenatal visit: history — obstetric, gynecologic, family, lifestyle.

W 11–13
All women (recommended tests) CBC Blood type and Rh Serological markers: HIV, syphilis Rubella and varicella IgG HBV screen Urinalysis (UA) Urine microscopy / urine micro Ultrasound (US): cardiac activity, number of fetuses, gestational age & size, EDD, anatomic changes	Risk of chromosomal abnormality Ultrasound markers CRL (crown–rump length) ~45–84 mm Nuchal translucency Nasal bone / nasal echogenicity Screen for twins ADP + PAPP‑A (maternal serum markers)

Chromosomal abnormality screening

Double test (first trimester)
Triple test (second trimester)
Ultrasound for parameters, fetal weight, fetal anomalies
AFP + uE3 + β‑hCG

Gestational diabetes screening

W24–28: 75 g OGTT

Infection screening

HIV and syphilis at W11–13
Group B Streptococcus (GBS) screening: W35–37
Asymptomatic bacteriuria screening: W12–16

Rh screening

W11–13
Week 20
W27

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