Abortions, Ectopic Pregnancy And Rh 2

Question 1

Preferred surgical treatment for the following ectopic pregnancy patients?
Hemodynamically unstable, stable, Fallopian tube is damaged, procedure for better long term tubal function?

Answer 1

Laparotomy
Laparoscopy
Salpingectomy
Salpingostomy

Question 2

Big picture what is the problem with rhesus?

Answer 2

Rh negative mom produced antibodies that attack Rh positive baby

Question 3

What antigen do Rh positive moms carry and what antigens do Rh negative moms lack? Over 90% of the cases of Rhesus, the antibodies are to what?

Answer 3

Have D
Lack D
Antibodies to D antigen

Question 4

Explain the response of mom to Rh positive baby and how do we treat it?

Answer 4

Mom initially makes IgM, then IgG which can cross the placenta and destroy RBCs of baby.
The RhoGAM shot prevents mom from making the antibodies

Question 5

Why does the attack happen on the second baby and not the first?

Answer 5

You need a good amount of baby blood to lead to a maternal response and that really only happens at delivery if everything is good during the pregnancy.

Question 6

When is Rh negative mom given the RhoGAM shot?

Answer 6

At 28 weeks, within 72 hours of delivery, or when there is a chance of more blood loss from baby,

Question 7

What is the Kleinhauer Betke Test?

Answer 7

Allows us to see how much fetal RBCs are in moms blood to see if we need to give additional doses of RhoGAM.

Question 8

Let’s say mom presents for her first prenatal appointment and she is Rh negative with positive antibodies, what is our next step?

Answer 8

Test dad to see what he is.
If he’s negative for the d antigen, nothing needs to be done because baby will be negative.
If he’s positive for the d antigen, then we need to figure out what baby is.

Question 9

What level of antibodies in mom tell us baby is ok or in danger?

Answer 9

Less than 1:8 baby is good

Greater than 1:16, we are concerned

Question 10

What are we looking for on US once we know baby is at danger? 2 things.

Answer 10

Fetal hydrops

Anemia

Question 11

What is the best way to assess for anemia and what is the value that tells us moderate to severe anemia?

Answer 11

Peak systolic velocity in MCA

Greater than 1.5

Question 12

What is the HCT of a fetus with severe anemia? How do we treat it?

Answer 12

Below 30% or 2 standard deviations below normal

Intrauterine transfusions

Question 13

Intrauterine pregnancies are usually performed during what weeks of gestation?

Answer 13

18-35