Rhesus disease and pregnancy

Question 1

describe the circumstances that cause rhesus isoimmunisiatoin (rhesus disease) 4

Answer 1

1 rhesus+ father with rhesus negative mother

2 rhesus antigens from first pregnancy go into mothers blood stream

3 mother produces anti-Rh antibodies in response to Rh antigens

4-next pregnancy - if its rhesus +ve, anti-rhesus from mother will cross placenta and damage fetal red blood cells

Question 2

when is rhesus incompatiability an issue
-what is the specific circumstance

Answer 2

rhesus postive father
rhesus negative mother
1st pregnancy resus positive
2nd (or future) pregnancy resus positive

Question 3

sigsn of haemolytic disease of the newborn antenatally 8

Answer 3

polyhydramnios

thickened placenta

hydrops - sub cut oedema

pleural/pericardial effusion

ascites

HSM

in-uterodemise

Question 4

postnatal signs of haemolytic disease of the newborn 5

Answer 4

jaundice

HSM

pallor

kernicterus

hypoglycaemia

Question 5

checking risk of rhesus isoimmunisation 2

Answer 5

maternal blood group and titre
-fetal blood group amnio, free fetal DNA (paternal blood group)

Question 6

methods of prevenitng rhesus isoimmunisation 2

Answer 6

blood transfusion vigilance

antiD- porphylaxis

Question 7

when is antiD required in early pregnancy 5

Answer 7

if mother is Rh negative

after ecoptic or molar pregnancy

after therapeutic termination of pregnancy

if ptx has <12wks vaginal bleed, which is heavy, repeated or asoc w severe pain

if ptx <12wks medical or surgical management of miscarriage

Question 8

when is anti-D used in later pregnancy

Answer 8

if mother is Rh negative

offer prophylaxis at 28weeks

after delivery
-testing of infant cord blood to determine if required
-testing of maternal blood to determine dose of Anti-D required

Question 9

Will anti-D always be required following the delivery of an infant in the following circumstances?

1 mother Rh +ve father Rh –ve

2 mother Rh –ve father Rh –ve

3mmother Rh –ve father Rh +ve

Answer 9

1 mother Rh +ve father Rh –ve
Not required, mother will not make antibodies

2. mother Rh –ve father Rh –ve
   Probably not required, Rh is recessive inheritancetherefore baby will be Rh –ve also
3. mother Rh –ve father Rh +ve
   Checkinfant’sRh status. 50/50 chance if father Dd. 100% iffather DD.