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9 Cards in this Set
- Front
- Back
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How should it be tested?
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Indirect Coombs’ test
At least once every trimester and after birth Direct Coombs’ test after birth Kleihauer test to assess quantum of fetomaternal bleed. |
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What kind of sensitising events in the first trimester of every RH neg women (without preformed anti D) require anti D?
And how mush shuold they get? |
— miscarriage;
— termination of pregnancy; — ectopic pregnancy; and — chorionic villus sampling. A dose of 250 IU (50 μg) Rh D immunoglobulin is sufficient to prevent immunisation by a fetomaternal haemorrhage of 2.5 ml of fetal red cells (5 ml whole blood) (level IV evidence). |
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What are sensitising events in second trimester?
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— genetic studies (chorionic villus sampling, amniocentesis and
cordocentesis); — abdominal trauma considered sufficient to cause fetomaternal haemorrhage; — each occasion of revealed or concealed antepartum haemorrhage (where the patient suffers unexplained uterine pain the possibility of concealed antepartum haemorrhage should be considered, with a view to immunoprophylaxis); — external cephalic version (performed or attempted); and — miscarriage or termination of pregnancy. |
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What is the does of anti D given in the 2nd and 3rd trimester?
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A dose of 625 IU (125 μg) Rh D immunoglobulin should be offered to
every Rh D negative woman with no preformed anti-D to ensure adequate protection against immunisation for the following indications after 12 weeks gestation (level IV evidence): |
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If a Rh Neg woman has no sensitising event does she still need anti D?
If so then how much? |
Universal prophylaxis with Rh D immunoglobulin to Rh D negativewomen with no preformed anti-D antibodies at 28 and 34 weeks gestation is generally regarded as best practice (level II evidence).
625 IU (125 μg) Rh D immunoglobulin |
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Do Rh neg mothers require Anti D post-natally?
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d) Post-natally, within 72 hours. All women who
deliver an Rh (D) positive baby should have quantification of feto-maternal haemorrhage to guide appropriate prophylaxis. - what the lecture says What guidelines say: Rh D immunoglobulin should be offered to every Rh D negative woman following delivery of an Rh D positive baby (level I evidence). In the short to medium term, the Working Party recommends that imported product (currently available as a 600 IU [120 μg] dose) be used for this indication, to ease pressure on domestic supply of Rh D immunoglobulin. Rh D immunoglobulin should not be given to women with preformed anti- D antibodies, except where the preformed anti-D is due to the antenatal administration of Rh D immunoglobulin. If it is unclear whether the anti-D detected in the mother’s blood is passive or preformed, the treating clinician should be consulted. If there is continuing doubt, Rh D immunoglobulin should be administered. The magnitude of the fetomaternal haemorrhage should be assessed by a method capable of quantifying a haemorrhage of ≥6 ml of fetal red cells (12 ml of whole blood). Further doses should be administered sufficient to prevent maternal immunisation. |
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What are some sources of RhD antigen?
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Rh D incompatible pregnancy
Rh D incompatible blood transfusion Injection of Rh+ blood (i/v drug abuse) |
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How do you estimate the risk of Rh disease?
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Paternal Rh phenotype & genotype
If father is –ve fetus will not be affected If father is +ve, find out if he is homozygous or heterozygous Genotype is indirectly determined with genotype frequency tables. or... Fetal Rh determination CVS Amniocentesis Fetal blood *Amniocentesis & PCR is the method of choice* |
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What is the management for first RhD sensitised pregnancy?
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from up todate not sure you'd really need to know all this. Just determine if baby is at risk (Ie neg mum pos dad) then titer if maternal AntiD if > 32 then amnio or free fetal DNA testing (it still might be Rh neg).
If you're sure it's Rh neg and you have increased Rh titer stays up then serial MCA dopplers |
