Exam 2: RH/ABO Incompatibility

Question 1

What is ABO incompatibility?

Answer 1

Type O patient becomes pregnant with a fetus with type A or B blood
Only happens in type O patients
Patient’s antibodies cross placenta and cause hemolysis of fetal blood cells

Question 2

What is Rh incompatibility?

Answer 2

Exposure of an Rh-negative pregnant patient to Rh-positive fetal blood during pregnancy or birth
Erythrocytes from fetal circulation leak into maternal circulation
Causes:
Miscarriage
Ectopic pregnancy
Abortion
Abdominal trauma
Abruption

Question 3

Nursing assessment for Rh incompatibility

Answer 3

Know patient’s blood type and Rh status
ALL pregnant PTs should have blood type and antibody testing
Rh negative who may become pregnant with Rh-positive fetus should obtain an indirect Coombs test to determine if they have developed isoimmunity to Rh antigen

Question 4

Indirect Coombs test

Answer 4

Tells us if sensitization has already occurred at some point

Question 5

Will Rhogam help a person who already has antibodies (positive indirect Coombs test)?

Answer 5

No because Rhogam is used to prevent sensitization and they already have antibodies so sensitization has already occurred

Question 6

What happens if the indirect Coombs test is negative?

Answer 6

No antibodies are present
Patient is a candidate for Rhogam

Question 7

How to prevent Rh sensitization?

Answer 7

Rhogam IM injection
Given to every Rh-negative non-immunized woman as prophylaxis between 28-32 weeks gestation and again within 72 hours after giving birth

Question 8

How does Rh immunoglobulin work?

Answer 8

Helps destroy any fetal cells in the maternal circulation before sensitization occurs
Inhibits maternal antibody production

Question 9

What is a direct Coombs test?

Answer 9

Done on the fetal blood cells
Shows if baby has cells with maternal antibodies

Question 10

Treatment of Rh sensitization

Answer 10

Monitor pregnancy closely
Monitor maternal anti-D alloantibodies
Fluctuations may indicate severe fetal anemia
Measure fetal blood flow velocities
Direct sampling of fetal circulation only done if necessary:
PUBS
Intrauterine RBC transfusion (rare)

Question 11

What is Version?

Answer 11

Try to turn baby from breech to vertex, chance you can have a small separation of placenta from uterus

Question 12

Every patient who can become pregnant should be treated with _______ if they are Rh negative and have a potential sensitization

Answer 12

Rhogam

Question 13

What is more severe, ABO incompatibility or Rh incompatibility?

Answer 13

Rh incompatibility