Although the number of patients with Rh isoimmunization in pregnancy has been decreasing in recent years, this category of patients contributes significantly to the perinatal mortality in Saudi Arabia. Recent advances in obstetric ultrasound and immunology have added new knowledge on how to manage this category of patients, and today almost all Rh-affected fetuses are potentially salvageable. This article presents these advances and discusses the implications they might have on perinatal care in Saudi Arabia.