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ObGyn Lecture > Isoimmunization > Flashcards

Isoimmunization Flashcards

1
Q

WHat is the formation of maternal antibodies?

A

Isoimmunization

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2
Q

What is the most common antigen involved in sioimmunization?

A

Rh specifically the D antigen

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3
Q

Patients with the D antigen are what?

A

Rh D-positive

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4
Q

When does isoimmunization occur?

A

Rh D-negative woman is pregnant with a fetus that is Rh D-positive. Can cause an antibody response against fetal RBCs

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5
Q

What characterizes isoimmunization?

A

hemolysis
bilirubin release
anemia

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6
Q

How much blood is sufficient to cause isoimmunization?

A

Less than 0.1 mL of Rh d-positive blood

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7
Q

Is IgG the first or secondary antibody response?

A

Secondary

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8
Q

What is the combination of fluid accumulation in at least 2 extravascular compartments called?

A

Hydrop fetalis

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9
Q

How do you diagnose isoimmunization?

A

Test for antibodies

The higher the titer, the more significant the antibody response

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10
Q

What do you do if fetal anemia or hydrophic changes are found?

A

Cordocentesis of percutaneous umbilical blood sampling (PUBS) to measure direct fetal HCT

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11
Q

How do you evaluate fetal anemia?

A

Amniotic fluid assessment of bilirubin levels
Loo for hydropic changes
Measure blood viscosity of MCA (will have increased flow)

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12
Q

How do you manage isoimmunity?

A

Direct transfusion under US guidance of antigen-negative rbc’s to the fetus (want HCT >30%)

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13
Q

What can you give for prevention of isoimmunization?

A

GIve RhoGAM or Rhophylac to all RhD-neg women at 28 weeks and w/i 72 hours of delivery

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14
Q

What is a test that can identify fetal erythrocytes in materal circulation and the appropriate dose of Rh immunoglobulin to be administered.

A

Kelihauer-Betke test

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15
Q

WHat is a test that can be used to determine if the patient has received sufficient antibody.

A

Indirect Coombs test (positive means the dosage was adequate)

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16
Q

What is the Kell Antigen?

A

Results from a blood transfusion. Unique anemia results from destruction and suppression of hematopoietic precursor cells and hemolysis is limited

17
Q

What is where there is maternal-fetal incompatibility usually associated with mild fetal anemia and newborn hyperbilirubinemia. Not associated w/ severe fetal disease.

A

ABO hemolytic disease

18
Q

What is the proliferating tropoblast that gives rise to a layer of extraembryonic mesoderm on its intersurface (outer)

A

Chorion

19
Q

What is the inner sac that develops at the dorsal surface of the embryonic dis forming a transparent sac that fills amniotic fluid.

A

Amnion

20
Q

What is where each fetus is surrounded by an amnion and a chorion?

A

Diamnionic/ dichoronic

21
Q

What is where each fetus is surrounded by an amnion, but a single chorion?

A

Diamnionic/ monochoroionic

22
Q

What is where twins will share a common sac as the amnion and chorion have already developed?

A

monoamnionic/ monochorionic

23
Q

What is where there is arterial-venous anastomoses that forms between the fetus resulting in blood flow from one to another?

A

Twin-twin transfusion syndrome

24
Q

What is the name for the twin that has impaired growth, anemia, hypovolemia, oligohydramnios (from decreased urine output)?

A

Donor twin

25
Q

What is the twin that may have hypervolemia, HTN, polycythemia, CHF, can have polyhydramnios (due to increased urine output)

A

Recipient twin

26
Q

What is when fetal weight is less than 10th percentile for gestational age?

A

IUGR (intrauterine growth restriction)

27
Q

What is later onset IUGR usually realted to?

A

Decreased placental function and nutrient transport

28
Q

WHat usually causes IUGR?

A

placenta growth early and rapidly compared to the fetus; has large surface area

29
Q

Which type of IUGR is more commonly associated w/ heritable factors, immunologic abnormalities, chronic maternal disease, fetal infection, multiple pregnancies?

A

Early-onset IUGR

30
Q

What constitutes a IUGR diagnosis?

A

A discrepancy of more than 2 cm

DO an ultrasound for biparietal diameter (BPD), head circumference (HC), femur length, abdominal circumference (AC)

31
Q

What syndrome is from the fetus’ attempt to compensate for poor placenta oxygen transfer by increasing the HCT o more than 5% resultin gin marked polycytehmia. Can lead to thrombosis, heart failure, hyperbilirubinemia.

A

Hyperviscosity syndrome

32
Q

What is where the infant weighs 4000-4500 grams or greater.

A

Fetal macrosomia

33
Q

What is an LGA infant?

A

Large for gestational age. >90%

34
Q

What is the best tool to r/o macrosomia?

A

Ultrasound

ObGyn Lecture (21 decks)

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