Mothers are exposed to the fetal Rh D antigen when barriers between fetal and maternal circulation (the syncytiotrophoblast and the cytotrophoblast) cease to function and fetal RBCs are lost into maternal circulation, this is called fetal-maternal hemorrhage (FMH). This antenatal mixing of fetal and maternal blood occurs frequently, even in asymptomatic women, and can lead to sensitization. While FMH is most common during labor, this can occur earlier in the pregnancy.
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