fandarast
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A 20-year-old woman who just delivered a viable male neonate was recently involved in a car accident where she was a restrained passenger. She was at 38 weeks of gestation when she arrived at the emergency department. She was "cleared" by the trauma and orthopedic teams and sent to the labor and delivery floor. There she began having vaginal bleeding and then went into labor spontaneously. The estimated blood loss with delivery was 900 mL, and now she is stable. After obtaining her prenatal
information you realize she is Rh negative and antibody D negative. You immediately give her one shot of Rh immune globulin. What is the next best step in management?
A. Perform a CBC
B. Transfuse packed red blood cells
C. Perform a Kleihauer-Betke test
D. Give additional Rh immune globulin
E. Assess neonatal Rh antigen status
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| inkspot
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e
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| nyimalay
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E.
If neonate is Rh positive, next is Kleihauer- Betke test to access amount of fetal RBC. Then additional immunoglobulin if needed.
Please correct me if i m wrong.
Thank you fandarast.
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| bigdino
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I think it's C. It seems like there was profuse bleeding and therefore one shot of RhoGam might not be enough. We need to assess the full extent of the feto-maternal bleed by a Kleihauer-Betke test
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| kaphoury
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e
if the neonate is Rh -ve, she will be in no need to receive RhoGAM, if neonatal Rh is proved to be +ve then a Kleihauer-Betke test is to be performed to amount the neonate RBC
Plz assess
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| Ivonne
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E 
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| inkspot
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the question doesnt mention if it was her first pregnancy or she has already del a few. The significance of which is that the baby might already have antibodies against his RBCs and might have developed hydrops
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| fandarast
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The answer is E.
In the management of an Rh-negative, unsensitized (i.e., antibody-negative) patient, you should know the Rh antigen status of the baby. If the baby is Rh negative, then there is no need for Rh immune globulin because the maternal immune system would not form any antibodies directed toward fetal red blood cells. Had the baby been Rh positive, the next step would be to quantitate the amount of fetomaternal blood transfusion by performing a Kleihauer-Betke test. Then, based on those results, you may give additional Rh immune globulin. A CBC or transfusion is not necessary in this scenario because this patient stopped bleeding and is "stable." A CBC or capillary hemoglobin concentration test is appropriate during the first postpartum day for all postpartum patients.
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| dr.wad
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good q ...
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| ricardoricardo
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E yes
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| grechita12
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E
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