Parameters:
(1) gestational age of the fetus
(2) D antigen status
(3) maternal condition
(4) presence of warning signs
(5) Kleihauer-Betke test result (if over 20 weeks gestation)
If the fetus is < 12 weeks in gestation:
(1) If the mother is D-negative, administer 50 µg (1 vial of MicroRhogam). Some physicians use 1 vial of regular Rhogam (300 µg) to ensure a super-adequate dose.
(2) If the mother is stable, then she can be discharged after management of injuries. Else hold for observation.
If the fetus is 12 - 20 weeks in gestation:
(1) If the mother is D-negative, administer 300 µg (1 vial of regular Rhogam).
(2) If the mother is stable, then she can be discharged after management of injuries. Else hold for observation.
If the fetus is > 20 weeks in gestation:
(1) Admit the mother to the obstetrics ward for initial evaluation and monitoring.
(2) If the mother is D-negative, administer at least 300 µg (1 vial of regular Rhogam). A higher dose is administered if the Kleihauer-Betke test is positive, indicating a fetomaternal hemorrhage.
(3) Perform a Kleihauer-Betke test to determine if there has been a fetomaternal hemorrhage. If positive, observe the patient and repeat the test in 24 hours.
(4) If warning signs (see above) are noted during the initial observation period continue monitoring the patient.
(5) If the mother is stable or if symptoms resolve after hydration, then she can be discharged once the acute injuries have been treated. She should be instructed to return if any problems occur.
