Immunity

Question 1

Why does the immune system change in pregnancy

Answer 1

Paternal antigens are expressed on fetal cells from 8-cell stage, which alerts the maternal immune system of a foreign body, risking rejection.
So the immune system must adapt to avoid rejection.

Question 2

How does it change starting with the decidua

Answer 2

Local changes in the decidua, high levels of progesterone, corticosteroids, and/or HCG act on the uterus to stop it rejecting the fetal cells.

Question 3

How do the immune cells change in the decidua

Answer 3

High levels of natural killer cells, macrophages, and regulatory T cells

Question 4

How does it change starting with progesterone

Answer 4

Rising levels of progesterone cause a natural suppression in immunity

Question 5

How does it change starting with white cell count

Answer 5

Increasing oestrogen causes the white cell count to rise. Especially during labour

Question 6

Examples of infectious diseases

Answer 6

Toxoplasmosis
Salmonella
all can result in miscarriage and stillbirth

Question 7

rhesus status and anti d applied to practice

Answer 7

Offer blood grouping and antibody screen, result: ABO, RhD status and prescience and absence of antibodies.
RhD negative offer prophylactic anti D at 28/40
Antibodies referral and closer monitoring required

Question 8

Why does anti D matter

Answer 8

It causes haemolytic disease in fetus/newborn which is caused by the destruction of fetal RBCs resulting in fetal anaemia and so less oxygen reaches fetal tissue, Odema and cardiac failure can develop. Can cause fetal death and infants are at high risk of pathological jaundice and may require blood transfusions

Question 9

Vaccinations at 8 weeks

Answer 9

6 in 1 vaccine, rotavirus, meningitis B

Question 10

Vaccinations at 12 weeks

Answer 10

6 in 1 vaccine (2nd dose), pneumococcal, rotavirus ( 2nd dose)

Question 11

Vaccinations at 16 weeks

Answer 11

6 in 1 vaccine (3rd dose), meningitis B (2nd dose)