Fetal hemolysis may occur in Rh-negative blood type pregnant with a second child. Depending on the antibody and ultrasound examination, there are management options such as observation and follow-up, fetal blood transfusion, and termination of pregnancy. Pregnant women with Rh-negative blood who are pregnant with their second child should seek medical attention as early as possible to check the titer of Rh antibodies. If there is no anti-D antibody in the blood, it means that the first child did not have an immune response to the Rh antigen, and it is only necessary to follow up the antibody titer every month starting from 18 to 20 weeks and observe the fetus with the delivery. If anti-D antibody is present in the blood of a pregnant woman, the antibody titer should be tested once a month, and once every two weeks after 24 weeks. If the antibody titer exceeds 1:32, the fetus has the possibility of hemolysis. At the same time, ultrasound should be used to observe whether the fetus has signs of hemolysis such as excessive amniotic fluid and pleural and abdominal effusion, and the degree of hemolysis can also be determined by invasive means such as amniocentesis and umbilical cord vascular puncture if necessary. Once the fetus is found to be severely hemolyzed and anemic, intrauterine transfusion through the abdominal cavity or blood vessels can be performed. Fetuses presenting with hemolysis are usually recommended for termination of pregnancy after promoting fetal lung maturation around 35 weeks, and newborns are usually hospitalized for a period of observation, intervention for anemia and jaundice, and blood exchange if necessary. Injections of anti-D immunoglobulin during pregnancy and after delivery are recommended to prevent hemolysis in the next fetus.The second pregnancy with Rh-negative blood is a risky situation, and it is important to follow up and seek medical attention if there is any discomfort to avoid risk to the mother and the fetus.