Favorable fetal outcome in a high-risk Rh-alloimmunized pregnancy with high indirect coombs titre complicated by systemic sclerosis: a rare case report

Abstract

Rh alloimmunization remains an important cause of fetal and neonatal morbidity despite anti-D prophylaxis. Pregnancy in diffuse systemic sclerosis is uncommon and associated with significant maternal and fetal risks. The coexistence of these two high-risk conditions is rare. Case Presentation: 25-year-old G2P1D1 with diffuse systemic sclerosis and Rh-negative blood group was managed with serial antenatal surveillance. Indirect Coombs titres progressively increased from 1:256 at 32 weeks to 1:512 at 34 weeks. Serial ultrasonography showed no evidence of hydrops fetalis and until delivery, fetal surveillance findings remained reassuring, with reactive third-trimester non-stress tests. Elective cesarean section was performed at 34+2 weeks for severe Rh alloimmunization with breech presentation. A healthy male neonate weighing 2.5 kg was delivered and managed successfully with phototherapy for neonatal hyperbilirubinemia. Conclusion: Favorable outcomes can be achieved through multidisciplinary care, close surveillance, and timely delivery.