Rh + and - and Coombs and blood types

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I am new to postpartum, and am having some trouble understanding how all this works. The blood type, rh positive or negative, Coombs. Does anyone have a simple or clear way of explaining this or direct me to a source that explains it well? Thank you

Also, do you guys offer tdap vaccines to the dad's on post partum?

Specializes in Public Health, Maternal Child Health.

good answers on the RH factor here, just wanted to add regarding dads and tdaps - the dad is not your patient, so how will you bill for the cost of the vaccine and get reimbursed for it? Dads should be advised to get it through their PCP, health clinic, walgreens, etc. Pregnant women should recieve the TDAP between 28-36 weeks pregnant, with each recurring pregnancy, in order to maximize antibody transfer to the fetus, which takes about 4 weeks, for optimal protection against the whooping cough until baby gets their first vaccine at 2 mos. Once prenatal clinics comply with this new ACOG/AAP/CDC recommendation, less tdaps should be given postpartum altogether. Just an FYI :)

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Specializes in Postpartum, Med Surg, Home Health.
good answers on the RH factor here, just wanted to add regarding dads and tdaps - the dad is not your patient, so how will you bill for the cost of the vaccine and get reimbursed for it? Dads should be advised to get it through their PCP, health clinic, walgreens, etc. Pregnant women should recieve the TDAP between 28-36 weeks pregnant, with each recurring pregnancy, in order to maximize antibody transfer to the fetus, which takes about 4 weeks, for optimal protection against the whooping cough until baby gets their first vaccine at 2 mos. Once prenatal clinics comply with this new ACOG/AAP/CDC recommendation, less tdaps should be given postpartum altogether. Just an FYI :)

Unfortunately we get quite a few moms with poor prenatal care, therefore we do often give tdap vaccines after they deliver their baby in the hospital.

For the dad's or significant other, we offer flue shots as well as the tdap. I guess we bill and get reimbursed just like a vaccine clinic would. They fill out paperwork etc. so it's almost like we are operating a little flu/tdap vaccine clinic for the dad's on our postpartum floor...

It's not fun for the nursing staff :( sometimes I am having to give 5 vaccine shots to the family upon discharge, which all requires a lot of paperwork and stuff. It would be easier to just direct them to a clinic, but I guess this hospital makes it very convenient for the pts :)

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Specializes in Public Health, Maternal Child Health.

That's awesome that your hospital offer that!! Bcuz even if you tell them to go get it done it means most of them probably won't. Convenience is a huge factor.

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Specializes in Labor and Delivery.

Our hospital also offers TdaP to fathers! They have to fill out paperwork and then all set!

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We do encourage all family members who will be caring for the baby to get vaccinated but we would not give it to them because they're not our patients. We do have an outpatient pharmacy where they can get it.

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Specializes in L&D.

So...my mom is RH Negative and her baby is RH Positive. Mom has Passive D Antibodies in her blood.

Does she get Rhogam?

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Specializes in L&D.

Klone,

So do they Do Coombs on moms or only test newborns?

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Specializes in Nurse Leader specializing in Labor & Delivery.

I've typically seen the test done on the newborn (direct Coombs).

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Specializes in L&D.

Yes so a positive Coombs means there was blood mixing at birth and the baby has developed antibodies. So mom gets her Rhogam to protect her next pregnancy and baby gets a closer watch of it's bili.

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Specializes in Maternal - Child Health.
So...my mom is RH Negative and her baby is RH Positive. Mom has Passive D Antibodies in her blood.

Does she get Rhogam?

Mom will not benefit from Rhogam. The purpose of Rhogam is to prevent Passive D Antibody formation. That has already occurred in this case. Rhogam will not bind to or de-activate antibodies that have already formed.

Rhogam is offered to women who have not yet developed Passive D Antibodies.

Anti-D (Rho) Immunoglobulin; Rho(D) immune globulin | Patient

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Specializes in Maternal - Child Health.
Yes so a positive Coombs means there was blood mixing at birth and the baby has developed antibodies. So mom gets her Rhogam to protect her next pregnancy and baby gets a closer watch of it's bili.

I think you are combining the 2 Coombs tests in your mind and coming to an incorrect conclusion. The Direct Coombs test is done on the newborn's blood. A positive result indicates increased risk of hyperbilirubinemia, which may be due to Rh incompatibility, ABO incompatibility, or other causes. The baby is Rh+ and does not form anti Rh antibodies.

The Direct Coombs is not an indicator of the mother's status and is not used to determine the appropriateness of Rhogam for mom.

The Indirect Coombs test indicates whether mom has developed Anti-D (anti-Rh) Antibodies. It is safe to assume that at the time of delivery, some mixing of mother's Rh- and baby's Rh+ blood may have occurred. That sets the stage for mom to develop Anti-D (anti-Rh) Antibodies that could potentially attack a future fetus in a future pregnancy. If mom's Indirect Coombs test after delivery is negative, then she receives Rhogam to prevent formation of these antibodies that could endanger future pregnancies. If her Indirect Coombs is positive, she already HAS antibodies, and will not benefit from Rhogam.

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