MANAGEMENT OF FETUS AND INFANT Flashcards by ZHIANNE DHUD CHAUNCIE BINDADAN

Enumerate the methods for fetal management

Fetal monitoring
Fetal ultrasound
Invasive monitoring
Intrauterine transfusion

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Explain fetal monitoring

This is a process where pregnant women with known RBC alloimmunization and / or history with HDFN needs to monitored using antibody titers and fetal assessment to determine the best time for delivery

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What test is done to determine the best time for delivery?

Fetal assessment

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What is used for Fetal ultrasound?

MCA-PSV

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MCA-PSV is used at what time of gestation to detect fetal anemia?

16 - 20 weeks of gestation

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The MCA - PSV is used from 16 - 20 weeks of gestation to detect what?

Fetal anemia

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What increases and decreases under MCA-PSV?

The blood velocity increases as the hemtocrit decreases

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What level of MoM under MCA-PSV indicate significant anemia?

> 1.5 MoM

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What are the 2 invasive monitoring? ``

Cordocentesis and Amniocentesis

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This is done to determine fetal hematocrit

Cordocentesis

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Cordocentesis is done if the MCS-PSV suggest what?

Moderate to severe anemia (>1.5 MoM)

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Where is the sample obtained for cordocentesis?

From the umbilical vein

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What is equipment is used for cordocentesis?

Ultrasound with color development

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How is the sample for cordocentesis from umbilical vein obtained?

By inserting cord into the placenta

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What do cordocentesis determines?

BHARDAPG

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In cordocentesis, intrauterine is indicated if the Hematocrit is?

Less that 30%

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The monitoring of amniotic bilirubin levels under amniocentesis is replaced by what?

MCA-PSV

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This method is previously used to measure bilirubin levels via optical density

Amniocentesis

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Previously, amniocentesis is used to measure bilirubin levels via?

Optical density @ 450nm

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Currently, amniocentesis is primarily used for?

Obtaining fetal DNA for genetic testing

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What level of Hemoglobin requires urgent intervention under amniocentsis?

8 g/dL

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IUT is performed when?

MCA-PSV is >1.5 MoM
Fetal hydrops is present
<10g/dL hemoglobin
Amniotic level is high

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What is the procedure of IUT?

RBCs are transfused into the fetal umbilical vein

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What is the goal of IUT?

Maintain the fetal hemoglobin at >10g/dL

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The IUT is repeated every ______ until delivery?

Every 2- 4 weeks

IUT is stopped after _____ gestation?

36 weeks gestation

What are the RBC selection unit for IUT?

Group O, RhD-negative ( or compatible with maternal antibodies) LHC

TRUE OR FALSE: Under the selection of RBC for IUT, it should not be irradiated to not prevent graft-versus-host disease

FALSE; Should be irradiated

Why should the RBCs for IUT selected needs to be irradiated?

To prevent graft-versus-host disease

TRUE OR FALSE: The RBCs for IUT selection should be Antigen-positive for maternal RBC antibodies

False; Antigen-negative

To optimize the volume effectiveness of IUT, what should be the level of the Hematocrit?

>70%

What could be the risks of Invasive procedures?

IPP Increased maternal antibody titers 1-3% risk of fetal complications Early second trimester IUT has poorer outcomes Long term neurocognitive impairment (4.8%)

The increased maternal Ab titer is due to?

Fetomaternal hemorrhage

Fetal complications under IUT is?

1 - 3%

The longterm neurocognitive impairment can happen to what age?

>2 years old

Give the two methods under management of the INFANT

Postnatal risks Cord Blood testing

Bilirubin accumulation can happen due to?

Immature metabolic pathways

Bilirubin accumulation can lead to?

Hyperbilirubinemia and Kernicterus

What can be used to treat hyperbilirubinemia and anemia?

Blood group product

This blood group may show weaker reactions with anti-A and anti-B due to immature antigen expression

ABO grouping

What is the cause of weak reactions with Anti-A and anti-B in ABO grouping?

Due to immature antigen expression

What blood group may cause Blocked Rh phenomenon and may cause false negative

Rh typing

What can happen under Rh typing?

Rh blocked phenomenon may cause false negative

What test can confirm the presence of anti-D?

Eluate testing

Infants do not have their own ___________?

Isohemagglutinins

This is the critical test for HDFN diagnosis

DAT

What do the positive DAT test indicates?

Maternal antibody coating RBCs

TRUE OR FALSE: The strength of reaction does not correlate with the severity of the HDFN

True

In cord blood testing elution studies is not routinely needed but useful in unclear cases of blocked RhD typing

Elution studies

Enumerate the treatment modalities for infant

Exchange transfusion Simple transfusions Phototherapy Intravenous Immune Globulin (IVIG)

This treatment method indicates when bilirubin levels reach critical thresholds

Exchange transfusions

What is the mechanism of Exchange transfusion?

Removes maternal antibodies and bilirubin while replacing RBCs

What blood sample to exchange transfusion used?

ORAI

Under exchange transfusions, RBCs + plasma will create?

Reconstituted whole blood

Under ET, RBC units with _____ days old are preferred to reduce hyperkalemia

<7-10days

Why does RBC units with less than 7-10 days more preferred under ET?

To reduce hyperkalemia

How many volume exchange replaces RBCs and removes bilirubin?

Two volume exchange

Two volume exchange replaces and removes how much of the RBCs and Bilirubin?

90% of RBCs and 50% of Bilirubin

Why is post exchange platelet count monitoring required?

To monitor for iatrogenic thrombocytopenia

What is the mechanism of simple transfusion?

The small volume volume or "top-off" RBC transfusions correct anemia postnatally

The hemoglobin threshold for simple transfusion is set by?

Neonatologists

What are the clinical signs of anemia?

Poor feeding and excessive sleep

What are the blood sample used in ST?

ALr

how many units of blood under ST will the hospitals keep?

1 unit

This treatment modality uses blue light to convert unconjugated bilirubin into excretable forms

Phototherapy

At what nm is phototherapy set?

460 - 490 nm

This surrounds the infant with light blanks

High doses of phototherapy

What do High doses of phototherapy surrounds the infant?

Light blanks

Phototherapy is effective to?

Mild to moderate hemolysis

This is used to reduce hyperbilirubinemia by competing with maternal Ab for Fc receptors on macrophages

IVIG

Under IVIG, in order to reduce HB what does it do?

It competes with the maternal Ab for macrophage Fc receptors

What do the IVIG do in relation to exchange transfusions?

It decreases ET