7.2.5 - Rhesus Isoimmunisation- exam

Question 1

Explain the prophylactic management of women who are rhesus negative during pregnancy

Answer 1

Antenatal
625 iu of RhD immunoglobin is administered at
- 28 weeks
- 34 weeks

Post partum
625 iu of RhD immunoglobin
- should be offered to every RhD negative woman unless the baby is RhD negative

RhD immunoglobin should not be given to women with pre-existing Anti D antibodies except if antenatal administration of RhD was given

Question 2

Explain the pathophysiology of rhesus isoimmunisation and the implications to the current and future pregnancies

Answer 2

Rh Negative mother carrying a RH positive baby
- Rh incompatibility occurs when a woman who is Rh-negative becomes pregnant
with a baby with Rh-Positive blood.
- Rh incompatibility, the woman’s immune system reacts and creates Rh
antibodies
- these antibodies help drive an immune system attack against the baby
- the woman’s body view the baby as a foreign object
- Rh negative does not affect first pregnancy however if you second or third pregnancy the antibodies that the woman was exposed to rh positive in the first birth can cross the placenta and attack the Rh-positive red cells if the next baby is Rh positive
- fetal implications
Anemia
Heart Failure
^spleen
Liver
APO
Jaundice
biliruben
neuro issues can occur

Question 3

Incorporate a woman centred approach, explain the midwife role and medical management for women experience rhesus isoimmunisation as part of the multi-disciplinary team across the continum,

Answer 3

• give prescribed anti D at 28 weeks & 3 weeks
• if baby is Rh positive give anti d within 72 hours
• blood tests

Question 4

List the sensitizing events of the first, second and third trimester of pregnancy

Answer 4

Trimester 1
- Spontaneous Abortion
- Pregnancy termination
- Ectopic pregnancy
- Chorionic Villi sampling

Trimester 2
- amniocentesis
- antepartum haemorrhage - placental
- abdominal trauma

Trimester 3
- external cephalic version
- ie if breech trying to move baby into the cephalic position
- antepartum haemorrhage
- abdominal trauma
- birth of the placenta

Question 5

Describe the pathway of a sensitizing event which leads to the production of anti-d

Question 6

Once iso immunised, what is the expected outcome for outcome for this pregnancy and subsequent pregnancy

Question 7

Describe the prophylactic management for Rhesus negative women in pregnancy and post birth

Answer 7

• indirect Coombes Test
• Keilhauer test measures fetal blood spill in maternal circulation

Question 8

what does RH mean

Answer 8

The Rh factor is an inherited protein that can be found on the surface of the red blood cell.
- If your blood type is positive, then your blood cells have the Rh protein.
- if your blood type is negative, then your blood cells lack the Rh protein

Question 9

How does Rh incompatibility affect the baby

Answer 9

• without preventive treatment
• Rh incompatibility destroys your baby’s red blood cells (hemolytic anemia) during
  pregnancy
• Red bloods cells are filled with iron rich protein (HB) they supplies the o2 to your
  baby
• Your baby’s red blood cells die faster then his or her body can make new ones

Question 10

Direct Coombs test

Answer 10

this is the test that is done on the newborn blood sample
a positive test means that the baby’s red blood cells have the mother’s antibodies attached to them
this puts them at a higher risk of jaundice
positive test
hyperbilirubinemia

Question 11

indirect coombes test (early in pregnancy)

Question 12

Kleihaurer test

Answer 12

measure the fetal blood spill into the maternal circulation