Fetal complications

Question 1

def. fetal hydrops

Answer 1

accumulation of fluid in >1 body cavity

Question 2

2 general causes of hydrops

Answer 2

1. immune

2. non-immune

Question 3

what is immune cause of hydrops

Answer 3

RBC alloimmunization

- the formations of antibodies against antigens found on RBCs (other than mother’s own)

Question 4

what causes most obstetric alloimmunizations

Answer 4

anti-D antibodies in the Rh system

Question 5

2 ways a mother can become alloimmunized

Answer 5

1. blood transfusion from an incompatible donor

2. pregnancy

Question 6

4 risks for Rh+ fetus

Answer 6

1. fetal anemia
2. hydrops
3. IUFD
4. newborn anemia

Question 7

how to test for alloimmunized woman

Answer 7

1. routine AN investigation of group and screen

2. get titres if found positive

Question 8

what is antibody titres test

Answer 8

indirect coombs

• PT serum is incubated with RBCs with antigen
• RBCs with antigen will be agglutinated
• more it can be diluted and agglutinated, the hgher the risk to fetus

Question 9

what is modern evaluation

Answer 9

1. fetal typing through cell-free fetal DNA in maternal blood
2. US monitoring for anemia

Question 10

how to use US for fetal anemia testing

Answer 10

US in MCA and those with anemia have higher velocity

Question 11

what to do if anemia found

Answer 11

1. fetal blood sample

2. intra uterine blood transfusion

Question 12

how to prevent

Answer 12

give Rh IG at least 72hrs before expected event

Question 13

**indications for rhogam (6)

Answer 13

All Rh- moms that:

1. deliver Rh+ baby
2. have abortion
3. have invasive procedure in preg.
4. have vag. bleed in preg.
5. have documented feto-maternal hemorrhage
6. routinely at 28wks

Question 14

2 general non-immune hydrops causes

Answer 14

1. with fetal anemia

2. without fetal anemia

Question 15

2 causes of hydrops with fetal anemia

Answer 15

1. baby is losing blood

2. baby is hemolyzing

Question 16

possible cause of baby losing blood

Answer 16

twin-twin transfusion syndrome

• vascular anastamoses
• both at risk for hydrops, heart failure and IUFD

Question 17

how to treat TTTS

Answer 17

laser ablation

Question 18

cause sof baby to be hemolyzing

Answer 18

parvovirus (slapped cheeks)

• receptor that virus binds to is on RBC
• shortens RBC life

Question 19

how to diagnose parvovirus

Answer 19

maternal AB

• if igG and not M - immune
• if IgM and not G - active

Question 20

causes of hyrdops without anemia (3)

Answer 20

1. baby has syndrome
2. baby has structural abnormality
3. baby is in heart failure

Question 21

3 possible chromo abnormalities

Answer 21

1. T21 - downs
2. turners - XO
3. T18 - edwards

Question 22

possible cause of fetal heart failure

Answer 22

supraventricular tachycardia

Question 23

findings in tachy

Answer 23

normal MCA flow

• sustained tachy (240bpm)
• mostly reentry syndromes

Question 24

managment of tachy (3)

Answer 24

1. if near term deliver and treat
2. if intermittent and no hyrops, monitor
3. is sustained - treat mother inpatient

Question 25

3 things in immediate post-natal assessment

Answer 25

Airway
Breathing
Circulation

Question 26

steps to resuscitate

Answer 26

1. initiate if fetus is depressed
2. initiate with bag and mask ventilation - can stop
3. chest compress if HR100 and breathing spont.

Question 27

5 parts of apgar score

Answer 27

Heart rate
Resp effort
Reflex Irritability
Mucle Tone
Color 

(Hor Ready Is This Child)

Question 28

how to interpret apgar

Answer 28

8

Question 29

what is transition

Answer 29

circulatory and blood flow changes