Alloimmune diseases -Early pregnancy care part2

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1) A 22-year-old primparous woman who is 34 weeks pregnant presents at the antenatal clinic. She is RhD negative with a RhD-positive fetus on cell-free fetal DNA. She attended hospital 1 week ago with an antepartum haemorrhage but did not receive anti-D.

2) RhD antigen-negative woman in her first pregnancy has been involved in a road traffic accident at 29 weeks of gestation without any vaginal bleeding but with trauma to the abdomen. She had received routine antenatal prophylaxis with 1500 units at 28 weeks. What is the most appropriate management?

3) A 34-year-old RhD-negative women is at 22 weeks of gestation in her second pregnancy and just completed an intrauterine platelet transfusion for alloimmunisation to platelets

4) 25-year-old women who is 10 weeks pregnant has anti-D antibodies in her booking bloods. What is the reliable method available at this gestation to determine the fetal RhD antigen status?

5) You have been asked to review the notes of a 31-year-old nulliparous woman who is now 12 weeks pregnant. She is fit and healthy with a BMI of 24. In the past she had surgical management for a missed miscarriage at 10 weeks of gestation.

The results of her booking bloods have been phoned through to the clinic and are as follows:

blood group: A Rhesus negative

antibody screen: anti-D antibodies present at 3 IU/ml.

6) A nervous 42-year-old woman presents to your antenatal clinic. She is anxious that she has missed the right time to have her combined test for Down syndrome screening. She is now 17 weeks pregnant and is very concerned about her age.

What assays would she be tested for at this gestation?

7) Blood components can cross the placenta in pregnancy but some are not able to do so. Which of the following can cross the placenta?

8) A RhD-negative women has a caesarean section; cell salvage is used intraoperatively. What is the most appropriate management?

9) A women in her fourth pregnancy is known to have anti-K antibodies. She is now at 22 weeks of gestation. What is the best management to investigate if anaemia is present in the fetus?

10) A 23-year-old multiparous woman at 29 weeks of gestation is referred to the antenatal clinic measuring large for dates (symphysio–fundal height = 34 cm).In her previous pregnancy, she had recurrent antepartum haemorrhage and had a normal delivery at 37 weeks of gestation of a baby girl weighing 2.9 kg.

So far, this pregnancy has progressed as expected with dating and anomaly scans both reporting no anomolies. However, at booking she was noted to have elevated anti-D levels (blood group = AB Rhesus negative). At 16 weeks of gestation, anti-D was 3 IU/ml and at 20 weeks of gestation it was 4 IU/ml. She missed her 24-week blood test due to a family holiday.

She had an ultrasound scan that showed polyhydramnios, fetal ascites and generalised fetal edema.A serum antibody screen performed last week shows anti-D levels of 18 IU/ml

11) A woman in her second pregnancy who is RhD antigen negative and has anti-D levels of 4 IU/ml has an antepartum haemorrhage at 24 weeks of gestation. What is the most appropriate management with regards to anti-D?

12) A 27-year-old primiparous woman attends for external cephalic version at 38 weeks of pregnancy. Ultrasound confirms a normally grown singleton adopting a flexed breech position, the amniotic fluid index is normal.Her BMI is 26 and blood group is O-negative. She received routine antenatal anti-D prophylaxis (1500 IU intramuscularly) at 28 weeks of gestation.

13) 30-year-old woman is pregnant with her third baby. She has had two previous normal vaginal deliveries with no complications. She is seen at her booking visit with her midwife and has bloods taken for antenatal screening.

Which of these is the most appropriate set of blood investigations for her?

14) A 31-year-old nulliparous women who is 16 weeks pregnant. At her booking bloods she was found to be O RhD negative with anti-c antibodies. The anti-c level is reported as 5 IU/ml.

15) A 34-year-old woman attends antenatal clinic at 41+0 weeks of gestation. She is pregnant with her third baby and has no complications. She had two previous normal vaginal deliveries, both of which were induced. She is adamant that she does not want induction of labour.

What is the most appropriate form of monitoring for her from 42 weeks of gestation?

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