Please clear my doubts

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Please clear my doubts

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pr20
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08/09/08 - 04:26 AM

1.UW says,regardless of gestational age or maturity of the lungs,the presence of maternal and fetal detoriation requires an immediate delivery,which is usually accomplished vaginally after induction of labor.C-Section is only done if vaginal delivary is not possible.

Kaplan book says that Nonreassuring FHR tracing is an indication for C-section.

Nonreassuring FHR tracing indicates fetal detoriation and if this is an indication for C-section,then what are the other signs of fetal detoriation which requires vaginal delivary before C-section???

2.If a pregnant women has Anti-D-antibodies when tested at 28 weeks,can we still give her RhoGAM???.Purpose of RhoGAM is to lyse foreign RBC antigens before the maternal lymphocytes become stimulated.But if the pregnant women already has Anti-D-antibodies,it indicates that her lymphocytes are already stimulated and started producing antibodies.In such circumstances is it useful to give her RhoGAM??.If RhoGAM should not be given in such patients,then how should we further proceed to prevent isoimmunization in such women???

pr20
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08/09/08 - 04:31 AM

3.What is the gestational age at which we do screening for asymptomatic bacteruria?

arlete
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08/09/08 - 08:48 AM

2. RhoGAM should not be given because what was supposed to be avoided already happened in this case. I don't know anything that could prevent the consequences for the fetus at this point.

3. The pregnant women have a urine test every single visit they have during the pregnancy, in USA. It rapidly checks for sugar, protein, ketones and bacteria.

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arlete
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08/09/08 - 08:50 AM

1. I am not sure. I think it depends on each case, there's no rule pre-stablished. "Maternal and fetal deterioration" are too broad terms.

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pr20
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08/09/08 - 09:33 PM

Thanks arlete.

arlete
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08/10/08 - 08:34 AM

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Dragonfly
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08/16/08 - 11:20 AM

well Kaplan doesn't say C-section all the time. considering the fact that EFM shows late decel.s and IU resus. has failed by this time, it means the baby is in jeopardy and should come out NOW!
Kaplan says if stage I --> C-section (b/c there is not enough time for the cervical rippening and dilation , etc. )

stage II --> vaginal OR C-section ( b/c the baby is half way down and engaged plus the cervix is 100% dilated and vaginal can be tried; if failed, proceed to C-section)

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seven_fingers
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08/16/08 - 11:47 AM

2. "we further proceed to prevent isoimmunization in such women??? "
cant prevent iso-immunisation but you can reduce hemolysis in teh fetus by PUBS-transfusion

3. asymptomatic bacturia screened initially at 8-10 weeks (usually date of first visit to doc)

1. what dragonfly says seems right

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Eagle_303
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08/16/08 - 06:20 PM

pr20 wrote:
1.
2.If a pregnant women has Anti-D-antibodies when tested at 28 weeks,can we still give her RhoGAM???.Purpose of RhoGAM is to lyse foreign RBC antigens before the maternal lymphocytes become stimulated.But if the pregnant women already has Anti-D-antibodies,it indicates that her lymphocytes are already stimulated and started producing antibodies.In such circumstances is it useful to give her RhoGAM??.If RhoGAM should not be given in such patients,then how should we further proceed to prevent isoimmunization in such women???

If the pregnant lady is already Antibody positive then we have to move step by step :

Step 1 :Titer of antibody .Titer < 1:8 is harmless ,if more than this then

Step 2 grin

etermine if these have crossed the placenta .It is determined by presence of hemolysis in the fetus which is determined by four methods

A: Indirect determination of hemolysis by measuring aminiotic fluid bilirubin and plotting it on the Liley Graph
Birect determination by determing Hct of fetal blood through PUBS
C: Fetal status by US if it has Hydrops or not
D=Fetatl heart status by US determining BVOD

Indications for intervention:

If delta OD450 is in zone III of Liley graph or
If Hct is < 25% or
If Hydrops is present or
If BVOD is > 95th percentile

What sort of intervention is required:Look if the

-- gestation is more than 34 weeks with lung maturity ---------go for delivery

--If gestation is less 34 weeks than Intrauterine transfusion is performed which may be intraperitoneal or intravascular in the umbilical cord.

Best of luck

bioguy
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09/11/08 - 11:24 AM

#10

whats BVOD?

pardon me, i lost touch with the abbs.

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