Fetal complications Flashcards
def. fetal hydrops
accumulation of fluid in >1 body cavity
2 general causes of hydrops
- immune
2. non-immune
what is immune cause of hydrops
RBC alloimmunization
- the formations of antibodies against antigens found on RBCs (other than mother’s own)
what causes most obstetric alloimmunizations
anti-D antibodies in the Rh system
2 ways a mother can become alloimmunized
- blood transfusion from an incompatible donor
2. pregnancy
4 risks for Rh+ fetus
- fetal anemia
- hydrops
- IUFD
- newborn anemia
how to test for alloimmunized woman
- routine AN investigation of group and screen
2. get titres if found positive
what is antibody titres test
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
what is modern evaluation
- fetal typing through cell-free fetal DNA in maternal blood
- US monitoring for anemia
how to use US for fetal anemia testing
US in MCA and those with anemia have higher velocity
what to do if anemia found
- fetal blood sample
2. intra uterine blood transfusion
how to prevent
give Rh IG at least 72hrs before expected event
**indications for rhogam (6)
All Rh- moms that:
- deliver Rh+ baby
- have abortion
- have invasive procedure in preg.
- have vag. bleed in preg.
- have documented feto-maternal hemorrhage
- routinely at 28wks
2 general non-immune hydrops causes
- with fetal anemia
2. without fetal anemia
2 causes of hydrops with fetal anemia
- baby is losing blood
2. baby is hemolyzing
possible cause of baby losing blood
twin-twin transfusion syndrome
- vascular anastamoses
- both at risk for hydrops, heart failure and IUFD
how to treat TTTS
laser ablation
cause sof baby to be hemolyzing
parvovirus (slapped cheeks)
- receptor that virus binds to is on RBC
- shortens RBC life
how to diagnose parvovirus
maternal AB
- if igG and not M - immune
- if IgM and not G - active
causes of hyrdops without anemia (3)
- baby has syndrome
- baby has structural abnormality
- baby is in heart failure
3 possible chromo abnormalities
- T21 - downs
- turners - XO
- T18 - edwards
possible cause of fetal heart failure
supraventricular tachycardia
findings in tachy
normal MCA flow
- sustained tachy (240bpm)
- mostly reentry syndromes
managment of tachy (3)
- if near term deliver and treat
- if intermittent and no hyrops, monitor
- is sustained - treat mother inpatient
3 things in immediate post-natal assessment
Airway
Breathing
Circulation
steps to resuscitate
- initiate if fetus is depressed
- initiate with bag and mask ventilation - can stop
- chest compress if HR100 and breathing spont.
5 parts of apgar score
Heart rate Resp effort Reflex Irritability Mucle Tone Color
(Hor Ready Is This Child)
how to interpret apgar
8
what is transition
circulatory and blood flow changes
