Pregnancy Complications 1

Question 0

Describe Rh blood incompatibility pathophysiology

Answer 0

1st pregnancy: fetal Rh+ blood is typically only encountered at birth, causing anti-D antibodies to be made but not enough to harm that get us.
Subsequent pregnancies: maternal antibodies are produced and can cross the placenta, increasing risk of hemolysis of fetal RBC’s

Question 1

Define Rh blood incompatibility

Answer 1

Occurs when mother is Rh- and baby receives Rh+ blood from father.
Baby will produce RBC’s with D antigens.
If maternal Rh- blood comes into contact with fetal blood, she will produce anti-D antibodies.

Question 2

What happens if maternal anti-D antibodies cross the placenta

Answer 2

Increased risk of hemolysis of fetal RBC’s which can lead to:

• severe anaemia
• tissue hypoxia
• fetal demise and death

Question 3

Women given anti-D antibodies (immunoglobulins)

Answer 3

This will destroy fetal cells present in maternal blood before they can stimulate the immune response

Question 4

Define obstetric cholestasis

Answer 4

Restricted/obstructed flow of bile from the liver during pregnancy
- generally during the 3rd trimester

Question 5

Symptoms of cholestasis

Answer 5

Pruritis: main manifestation
Elevated bile acids
Elevated liver enzymes (transaminase)
Jaundice (<10% of cases)

Question 6

Risk factors of cholestasis

Answer 6

• genetic predisposition/ family hx
• multiple pregnancy
• precious obstetric cholestasis
• gallstones (cholelithiasis)

Question 7

Cholestasis Pathophysiology

Answer 7

Estrogens and progesterone may play a role in slowing down the rate at which bile is passed through bile ducts of the liver
Hormone levels rise in 3rd trimester.
Reduced flow of bile to the GI tract = retention of bile acids & leakage into the blood stream

Question 8

Estrogens & cholestasis

Answer 8

Estrogens increase production of proteins, enzymes, cholesterol & bilirubin in the liver = could congest bile flow

Question 9

Progesterone and cholestasis

Answer 9

Relaxes the gall bladder and bile duct system = may slow or reduce bile flow and lead to congestion

Question 10

Acute fatty liver of pregnancy (AFLP)

Answer 10

Accumulation of fat (lipids) within liver cells (hepatocytes)
- generally occurs during the 3rd trimester

Question 11

AFLP Symptoms

Answer 11

• nausea/vomiting
• headache/confusion/fatigue
• hypertension/HELLP/preeclampsia
• elevated liver enzymes & WBC’s
• hypoglycaemia/diabetes insipidus
• jaundice/hyperbilirubinemia
• abdominal pain

Question 12

AFLP risk factors

Answer 12

• primigravida
• pre-eclampsia
• male fetus
• multiple pregnancy