Download - Med4just

Ms W is 33 years teacher and at 18 weeks gestation of her second pregnancy . she
experienced heavy vaginal bleeding with the passage of products of conception . her
blood group is O- .
1.
2.
3.
4.
What are the blood groups of the fetus and the father to expect Rh incompatibility ?
Mention two other events that may lead to Rh sensitization ?
Mention two factors that the rhesus antibodies development depend on them ?
By which test we can determine the proportion of fetal cells in the mother circulation
?
5. By which test we can determine the amount of the prophylactic dose of anti –D ?
6. By which test we can determine if the mother is sensitized or not ?
7. What is the prophylactic dose of anti –D for this patient ?
ANSWERS :
1.any blood group with the rhesus factor positive "O+ ".
2. a- delivery
b- antepartum hemorrhage
3. a-inborn ability to respond b- ABO compatibility
4. Kleihauer-Betke test
5. Kleihauer-Betke test
6. direct or indirect coomb,s test
7. half of the standard dose " 250 IU "
A primigravida deliver her full term baby weighting 3 Kg . her blood group is A- and
the infant blood group is A+.
1. When to give her the prophylactic anti-D dose ?
2. What is the prophylactic dose of anti –D for her?
3. Does rhesus disease affect the first pregnancy ?
ANSWERS :
1. Within 72 hours after delivery .
2. A- the British school , standard doses of 500 IU are given subsequently according
to Kleihauer-Betke test .
B – the American school , a booster dose of 1500 IU is given in all cases .
3. rhesus disease dose not affect the first pregnancy unless the mother was
sensitized before the first pregnancy by receiving an Rh- positive blood
transfusion .
A 30 years housewife and at 32 weeks gestation in her fourth pregnancy .her
blood group is B- , her first child was full term and 3.5 Kg and his blood group is
AB+ ,and she did not take anti –D prophylactic dose , the second child born with
jaundice and anemia , in the third pregnancy there was intrauterine fetal death
at 34 weeks gestation .
1. is there a role for the use of Anti-D injection ?
2. what could be done if isoimmunization was discovered before 20 weeks of
gestation ?
3. when to do amniocentesis ?
4. dose the level of bilirubin in amniotic fluid correlate with the severity of fetal
anemia ?
5. other than amniocentesis how the severity of fetal anemia can be predicted ?
6. according to Whitefield,s action line what will be done ?
7. mention three prognostic factors ?
8. what will be done for the infant after delivery ?
ANSWERS :
1. there is NO role for the use of Anti-D injection
2. plasmaphoresis to wash all the maternal antibodies and it can be done as early as
12 weeks
3. at 20 weeks gestation when the antibody titer more than 5 IU
4. yes it correlate roughly with the degree of hemolysis and thus indirectly predicts
the severity of fetal anemia ,mild moderate or sever according to Liley,s chart
5. by Doppler study for the fetal middle cerebral artery
6. if bilirubin is in Liley,s third zone and as it less than 34 weeks then intrauterine
fetal transfusion is done. until 34 weeks then the fetus will be delivered
7. a- paternal genotype b- maternal history of blood transfusion c- antibody titer
8. a- mild cases can be treated with phototherapy and correction of acidosis
b- sever cases may need exchange transfusion
DONE BY :
IBRAHEM KAMEL