{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:34:08Z","timestamp":1783942448597,"version":"3.55.0"},"reference-count":67,"publisher":"Federacion Colombiana de Obstetricia y Ginecologia","issue":"3","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["revista.fecolsog.org"],"crossmark-restriction":false},"short-container-title":["Rev. colomb. obstet. ginecol."],"abstract":"<jats:p>Objetivos: capacitar a los profesionales de la salud involucrados en la atenci\u00f3n de la mujer gestante con Rh-D (-), con el fin de estandarizar el manejo de la prevenci\u00f3n de la isoinmunizaci\u00f3n Rh, el diagn\u00f3stico antenatal oportuno de la enfermedad Rh, la evaluaci\u00f3n del estado del feto y el tratamiento del feto con enfermedad Rh, buscando prevenir desenlaces perinatales adversos.\nMateriales y m\u00e9todos: grupo de 23 expertos panelistas que participaron en el desarrollo del consenso en tres rondas para contestar un cuestionario de 8 dominios y 22 preguntas. Se utiliz\u00f3 el m\u00e9todo Delphi modificado, hasta alcanzar el umbral de consenso entre los participantes, definido como un acuerdo en las respuestas mayor o igual al 80 %. En la tercera ronda del panel de expertos surgi\u00f3 una vig\u00e9sima tercera pregunta que respondi\u00f3 uno de los l\u00edderes tem\u00e1ticos. Los ocho dominios del manejo antenatal de la gestante Rh-D negativa fueron: 1) la determinaci\u00f3n del Rh-D, 2) el control prenatal inicial de la paciente Rh-D negativa, 3) la titulaci\u00f3n y periodicidad del Coombs indirecto, 4) los eventos sensibilizantes, 5) la administraci\u00f3n de la inmunoglobulina (IgG) anti-D, 6) la velocimetr\u00eda Doppler de la arteria cerebral media (ACM), 7) el manejo antenatal de la paciente isoinmunizada y del feto an\u00e9mico, 8) el tiempo para la finalizaci\u00f3n de la gestaci\u00f3n de acuerdo con los diferentes escenarios cl\u00ednicos. A partir de estas respuestas, y de la revisi\u00f3n de gu\u00edas de pr\u00e1ctica cl\u00ednica internacionales, se formularon las declaraciones del consenso que incluyen las recomendaciones, su justificaci\u00f3n y su adaptaci\u00f3n al contexto local.\nResultados: se formularon las siguientes recomendaciones:\n1.Se sugiere que la mujer en edad f\u00e9rtil Rh-D negativa acuda a una consulta preconcepcional.\n2. Se recomienda la determinaci\u00f3n del Rh-D materno en el primer contacto de la mujer con los servicios de salud, en la consulta preconcepcional o en el primer control prenatal.\n3. En las pacientes Rh-D negativas se recomienda determinar el Rh-D del padre del hijo(a) durante el control prenatal tan temprano como sea posible, preferiblemente antes de la semana 28 de gestaci\u00f3n.\n4. En la primigestante Rh-D negativa, donde el padre de su hijo(a) sea Rh-D positivo, se sugiere: a) la determinaci\u00f3n y titulaci\u00f3n de anticuerpos Rh-D (Coombs indirecto cuantitativo) durante la primera consulta y luego trimestralmente, b) la ampliaci\u00f3n de la historia obst\u00e9trica con \u00e9nfasis en la b\u00fasqueda e identificaci\u00f3n de eventos sensibilizantes, c) ofrecer consejer\u00eda parental acerca de probables riesgos, el requerimiento de ex\u00e1menes adicionales y la posibilidad de inmunizaci\u00f3n durante el embarazo.\n5. En la consulta de control prenatal de una paciente mult\u00edpara Rh-D negativa, con hijo(s) previo(s) Rh-D positivo(s), como conducta inicial se sugiere: a) determinar y titular los anticuerpos Rh-D (Coombs indirecto cuantitativo); b) ampliar la historia obst\u00e9trica, haciendo \u00e9nfasis en eventos sensibilizantes; c) realizar consejer\u00eda parental acerca de probables riesgos y ex\u00e1menes adicionales.\n6. Tras un evento sensibilizante, se recomienda la administraci\u00f3n de IgG anti-D en las primeras 72 horas a dosis de 1500 IU (300 \u03bcg), de no ser posible, hasta 4 semanas despu\u00e9s de un evento sensibilizante, si no se aplic\u00f3 inicialmente.\n7.1. En la gestante no isoinmunizada (con prueba Coombs [-] y reci\u00e9n nacido Rh [+]) se recomienda la administraci\u00f3n de IgG anti-D entre la semana 28 y la semana 32, y en las primeras 72 horas posparto si el reci\u00e9n nacido es Rh (+). La dosis es de 300 \u03bcg IM o IV.\n7.2. En un parto por ces\u00e1rea de una paciente Rh-D negativa con hijo Rh-D positivo, el consenso no recomienda duplicar la dosis de IgG anti-D. La dosis para utilizar es igual a la indicada posterior al parto vaginal: 300 \u03bcg IM o IV.\n7.3. En un parto gemelar de una paciente Rh-D negativa, con dos o m\u00e1s reci\u00e9n nacidos vivos Rh-D positivos, el consenso recomienda no duplicar la dosis de la IgG anti-D. La dosis para utilizar es igual a la indicada posterior al parto vaginal: 300 \u03bcg IM o IV.\n7.4. En la paciente Rh-D negativa no isoinmunizada en puerperio con esterilizaci\u00f3n tub\u00e1rica quir\u00fargica posparto inmediato, con neonato Rh-D positivo, se recomienda la administraci\u00f3n de IgG anti-D cuando no exista evidencia de sensibilizaci\u00f3n previa, dada la probabilidad de cambio de decisi\u00f3n de deseo reproductivo o falla del m\u00e9todo.\n8. Se debe considerar que una paciente Rh-D negativa se encuentra isoinmunizada en uno de los siguientes casos: a) cuando el Coombs indirecto est\u00e9 positivo en cualquier t\u00edtulo, siempre y cuando no haya recibido IgG anti-D el mes anterior a la realizaci\u00f3n de la prueba, o b) cuando se identifiquen antecedentes de desenlaces perinatales adversos asociados a enfermedad Rh en embarazos anteriores como hidrops.\n9.1. Si las mujeres Rh-D negativas se encuentran isoinmunizadas, es necesario determinar el valor del t\u00edtulo de anticuerpos anti-D, dado que ese t\u00edtulo se correlaciona con la severidad de la enfermedad y determina la necesidad de realizar estudios de anemia fetal con velocimetr\u00eda Doppler de la ACM.\n9.2. En la paciente Rh-D negativa isoinmunizada, se recomienda el seguimiento mediante la determinaci\u00f3n del Coombs indirecto cuantitativo mensualmente hasta la semana 24 y, posteriormente, cada dos semanas, o hasta obtener un t\u00edtulo cr\u00edtico (\u2265 1:16).\n10.1. Se sugiere solicitar el Doppler de la ACM en aquellas pacientes Rh-D negativas, con Coombs indirecto positivo cuyos t\u00edtulos sean \u2265 1:16.\n10.2. En una paciente Rh-D negativa no isoinmunizada, el consenso no recomienda la realizaci\u00f3n de velocimetr\u00eda Doppler de la ACM.\n10.3. Se recomienda la realizaci\u00f3n semanal de ecograf\u00eda Doppler de ACM en la paciente isoinmunizada con t\u00edtulos de Coombs indirecto \u2265 1:16.\n10.4. El consenso sugiere se adopte como punto de corte del Doppler de la ACM un valor igual o mayor a 1,5 m\u00faltiplos de la mediana (MoM) del pico sist\u00f3lico para la edad gestacional, puesto que este es el valor que mejor se correlaciona con anemia fetal.\n11. El consenso sugiere realizar cordocentesis cuando se sospeche anemia fetal y transfusi\u00f3n fetal intrauterina cuando la cordocentesis muestre valores de anemia fetal severa. Este procedimiento debe ser llevado a cabo por personal entrenado.\n12. Se recomienda prolongar el embarazo hasta que el feto tenga la maduraci\u00f3n pulmonar y tisular que le permita mejorar su sobrevida perinatal, seg\u00fan el punto de corte del t\u00edtulo de diluciones del Coombs indirecto.\nConclusiones: es necesario abordar de manera adecuada y estandarizada a las gestantes con grupo sangu\u00edneo Rh-D negativo, a las isoinmunizadas y a los fetos con enfermedad Rh, acorde con el contexto colombiano desde todos los niveles de atenci\u00f3n prenatal. Se espera que las recomendaciones emitidas en este consenso contribuyan a mejorar la atenci\u00f3n cl\u00ednica, as\u00ed como el impacto en la salud perinatal y en la calidad de vida neonatal de la enfermedad Rh.<\/jats:p>","DOI":"10.18597\/rcog.4142","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T18:48:56Z","timestamp":1728326936000},"update-policy":"https:\/\/doi.org\/10.18597\/crossmark","source":"Crossref","is-referenced-by-count":1,"title":["Consenso colombiano de diagn\u00f3stico, prevenci\u00f3n y manejo de la enfermedad Rh","Colombian consensus for the diagnosis, prevention, and management of Rhesus disease"],"prefix":"10.18597","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2431-9062","authenticated-orcid":false,"given":"Jes\u00fas Andr\u00e9s","family":"Benavides-Serralde","sequence":"first","affiliation":[{"name":"Maternal-Fetal Medicine Unit Perinatal, Care IPS; Gynecology and Obstetrics Service, Cl\u00ednica San Rafael; Department of Gynecology and Obstetrics, Fundaci\u00f3n Universitaria Aut\u00f3noma de las Am\u00e9ricas. Pereira (Colombia)."},{"name":"Unidad de Medicina Materno-Fetal Perinatal Care IPS. Servicio de Ginecolog\u00eda y Obstetricia, Cl\u00ednica San Rafael. Departamento de Ginecolog\u00eda y Obstetricia, Fundaci\u00f3n Universitaria Aut\u00f3noma de las Am\u00e9ricas. Pereira (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-5430","authenticated-orcid":false,"given":"Marcela","family":"Buitrago-Leal","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Cl\u00ednica de la Mujer, Cl\u00ednica del Country y Hospital Universitario San Ignacio; Professor, Pontificia Universidad Javeriana; Coordinator of the Maternal and Perinatal Health Committee, Federaci\u00f3n Colombiana de Obstetricia y Ginecolog\u00eda (FECOLSOG). Bogot\u00e1 (Colombia)."},{"name":"Unidad de Medicina Materno-Fetal Cl\u00ednica de la Mujer, Cl\u00ednica del Country y Hospital Universitario San Ignacio; Profesora, Pontificia Universidad Javeriana; Coordinadora del Comit\u00e9 de Salud Materno y Perinatal, FECOLSOG. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-938X","authenticated-orcid":false,"given":"Saulo","family":"Molina Giraldo","sequence":"additional","affiliation":[{"name":"Fetal Therapy, Surgery and Fetoscopy Unit, Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Hospital de San Jos\u00e9; Department of Gynecology and Obstetrics, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS); Fetal Therapy and Surgery Network - FetoNetwork, Colombia; Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Nacional de Colombia.  Bogot\u00e1 (Colombia)."},{"name":"Unidad de Terapia, Cirug\u00eda Fetal y Fetoscopia, Divisi\u00f3n de Medicina Materno-fetal, Departamento de Obstetricia y Ginecolog\u00eda, Hospital de San Jos\u00e9; Departamento de Ginecolog\u00eda y Obstetricia, Fundaci\u00f3n Universitaria de Ciencias de la Salud (FUCS); Fetal Therapy and Surgery Network - FetoNetwork, Colombia; Departamento de Obstetricia y Ginecolog\u00eda, Facultad de Medicina, Universidad Nacional de Colombia. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0141-4809","authenticated-orcid":false,"given":"Juan Pablo","family":"Benavides Calvache","sequence":"additional","affiliation":[{"name":"Maternal and Child Unit, Department of Gynecology and Obstetrics, Fundaci\u00f3n Valle del Lili; Coordinator of Specialization in Maternal-Fetal Medicine, Universidad ICESI. Cali (Colombia)."},{"name":"Unidad Materno Infantil, Departamento de Ginecolog\u00eda y Obstetricia, Fundaci\u00f3n Valle del Lili; Coordinador Especializaci\u00f3n en Medicina Materno-Fetal, Universidad ICESI. Cali (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0944-309X","authenticated-orcid":false,"given":"Isabella","family":"Rivera Tobar","sequence":"additional","affiliation":[{"name":"Postgraduate program in Gynecology and Obstetrics, School of Medicine, Pontificia Universidad Javeriana. Bogot\u00e1 (Colombia)."},{"name":"Posgrado de Ginecolog\u00eda y Obstetricia, Facultad de Medicina, Pontificia Universidad Javeriana. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3698-1706","authenticated-orcid":false,"given":"Melva Juliana","family":"L\u00f3pez Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Postgraduate program in Gynecology and Obstetrics, School of Medicine, Pontificia Universidad Javeriana. Bogot\u00e1 (Colombia)."},{"name":"Posgrado de Ginecolog\u00eda y Obstetricia, Facultad de Medicina, Pontificia Universidad Javeriana. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0372-8374","authenticated-orcid":false,"given":"Jezid","family":"Miranda","sequence":"additional","affiliation":[{"name":"Intensive Care and Obstetrics Research Group (Gricio), Department of Gynecology and Obstetrics, Universidad de Cartagena; Centro Hospitalario Serena del Mar. Cartagena (Colombia); Fundaci\u00f3n Santa Fe de Bogot\u00e1. Bogot\u00e1 (Colombia)."},{"name":"Grupo de Investigaci\u00f3n en Cuidado Intensivo y Obstetricia (Gricio), Departamento de Ginecolog\u00eda y Obstetricia, Universidad de Cartagena; Centro Hospitalario Serena del Mar  Cartagena de Indias (Colombia); Fundaci\u00f3n Santa Fe de Bogot\u00e1. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catalina","family":"Valencia","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Unit, Cl\u00ednica Del Prado, Universidad CES., Medell\u00edn (Colombia). Fundared Materna. Bogot\u00e1 (Colombia)."},{"name":"Unidad de Medicina Materno Fetal, Cl\u00ednica Del Prado, Universidad CES. Medell\u00edn (Colombia); Fundared Materna. Bogot\u00e1 (Colombia)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7913","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"100044","doi-asserted-by":"crossref","unstructured":"Visser G, Di Renzo G, Spitalnik S. 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