W11_08 fetal complications

Question 1

define fetal hydrops

Answer 1

abnormal accumulation of fluid in >1 body cavity

Question 2

note: we can break fetal hydrops into immune and non-immune etiologies

Answer 2

we will discuss anti-D antibody

Question 3

define RBC alloimmunization

Answer 3

the formation of antibodies (IgM, then IgG) against atigens found on RBCs other than the mother’s own

Question 4

name the major RBC antigen groups

Answer 4

ABO;
lewis;
CDE(Rh);
kell;
duffy

Question 5

which of kell and lewis antibodies kills?

Answer 5

kell kills;
lewis lives

Question 6

what is hemolytic disease of the newborn?

Answer 6

when the mother has anti-D antibodies that transfer to and attack the fetus she’s carrying. Often will happen in the second pregnancy, after the mother is exposed to RhD antigen from the first + baby

Question 7

what are some risks of Rh+ fetus?

Answer 7

fetal anemia;
hydrops;
IUFD (intrauterine fetal demise);
newborn anemia, severe jaundice

Question 8

what is IDAT?

Answer 8

indirect antiglobulin test;
is the reciprocal of the highest dilution of maternal serum that still produces RBC agglutination (1:32,1:64,1:128,etc)

Question 9

what are modern methods for checking RhD status of the baby

Answer 9

fetal typing (e.g. NIPT)
U/S monitoring for fetal anemia

Question 10

how to assess for fetal anemia with U/S?

Answer 10

higher blood flow velocities in anemic fetuses (e.g. check MCA)

Question 11

what are indications for RhIG? Women to:

Answer 11

deliver an Rh+ baby;
have an abortion;
have an invasive procedure in pregnancy;
have vaginal bleeding in pregnancy;
have documented feto-maternal hemorrhage (e.g. w/betke-kleihauer)

Question 12

note: Rh- women get Rhogam at 28 weeks of pregnancy, except when?

Answer 12

if the father is Rh-NEG, the test is not routinely done

Question 13

what is TTTS (twin-twin transfusion syndrome)?

Answer 13

vascular anastomoses allow for shunting of blood from one twin (donor) to the other (recipient)

Question 14

what’s the treatment for TTTS?

Answer 14

expectant (poor outcome);
serial amniocentesis (rare, temporizing method);
laser ablation of placental anastomoses (gold standard)

Question 15

what is parvovirus infection in the fetus?

Answer 15

causes anemia in the fetus due to antibodies against parvovivrus. causes slapped-cheek or fifth disease in children.

Question 16

what are some chromosomal causes of fetal hydrops without anemia?

Answer 16

T21 down syndrome;
45XO turner syndrome;
T18 edward’s syndrome

Question 17

what are some structural causes of non-immune hydrops with no fetal anemia?

Answer 17

heart failure (from fetal supraventricular tachycardia)

Question 18

what do we do for the newborn assessment?

Answer 18

immediate postnatal assessment;
apgar score;
transitioning;
newborn exam;
other measures for prematurity

Question 19

what are the 5 categories used in the apgar score?

Answer 19

heart rate;
resp effort;
reflex irritability;
muscle tone;
colour