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8 Cards in this Set
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- Back
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A 32-year-old woman presents at 25 weeks' gestation in her third pregnancy with a positive antibody screen. She is known to be Rh-negative with an Rh-positive sexual partner. Two previous children were born overseas: the first child was carried to term and is healthy. The second child, also born at term, was incubated in the immediate neonatal period due to jaundice. The patient did not have anti-D prophylaxis given antenatally or postpartum in the previous pregnancies. Physical examination is normal. Condition?
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Rh- incompatibility
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A 38-year-old primigravida woman presents for routine antenatal care. Her blood type is known to be Rh-negative with a negative indirect Coombs test, and her sexual partner is Rh-positive. She has been counselled regarding the need for Rh immunoprophylaxis at 28 weeks of pregnancy and postpartum if her newborn is found to be Rh-positive. Condition?
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Rh- incompatibility
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Manifestations of severe erythroblastosis fetalis include ultrasound evidence of significant effusions in serous cavities, organomegaly, polyhydramnios, and extensive skin oedema (anasarca). Anti-RhD antibody titres in severe disease are usually high (>1/32 dilutions). Anti-Kell's antibodies may be associated with profound fetal anaemia and hydrops in the presence of low antibody titres due to suppression of erythropoiesis. Evidence suggesting severe fetal anaemia includes high peak systolic velocities in the middle cerebral artery, low biophysical profile scores, and a sinusoidal fetal heart rate pattern. Although these manifestations of severe fetal disease are usually not detected in a first affected pregnancy, significant fetomaternal haemorrhage from any cause may lead to a secondary immune response and hydrops fetalis, even in a primiparous patient. Condition?
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Rh- incompatibility
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Rh- incompatibility - Ix?
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maternal blood type - Rh-negative
maternal serum Rh antibody screen - positive screen |
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Rh- incompatibility DDx
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Non-immune fetal hydrops
Parvovirus infection Non-RhD haemolytic disease Placental chorioangioma Fetomaternal haemorrhage Twin-twin transfusion syndrome |
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Rx Rh- incompatibility
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anti-D immunoglobulin
intravascular intrauterine blood transfusions |
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Other important Ix for Rh- incompatibility
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maternal serum antibody titre - >1:16 (may vary among laboratories)
paternal blood type - Rh-positive paternal zygosity - homozygous or heterozygous fetal ultrasound - may show subcutaneous oedema, ascites, pleural effusion, or pericardial effusion Doppler velocimetry of fetal middle cerebral artery-peak systolic velocity - ≥1.5 fetal blood type sampling (from amniocentesis or maternal circulation) - Rh type, fetal haemoglobin and haematocrit spectral photometry of amniotic fluid - Queenan's curve: rising or plateauing optical density 450 nm (AOD450); Liley's curve: AOD450 reaches the 80th percentile in second zone rosette test - may be positive Kleihauer-Betke's test/flow cytometry - variable |
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Rh- incompatibility Cx
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hyperbilirubinaemia and kernicterus - short term - high
transfusion-related fetal bradycardia - short term - low transfusion-related neurodevelopmental abnormalities - long term - low fetal and neonatal hydrops - variable - high neonatal anaemia - variable - high |
