NBME F1B1Q35 - Newborn in severe resp distress - maritzasf

[ArchivalUser]

Q-35
A newborn is in severe respiratory distress immediately following delivery. She was born at 35 weeks' gestation to a 35-year-old woman, gravida 2, para 1, aborta 1, who did not receive prenatal care. The newborn's pulse is 60/min, and respirations are irregular and labored. Examination shows pallor with perioral cyanosis, anasarca, hepatosplenomegaly, and scattered petechiae. Cord blood hemoglobin is 4 g/dL, and reticulocyte count is 18%. A direct antiglobulin (Coombs') test is positive. Which of the following sets of blood groups is most likely in the mother and her newborn?

Mother Newborn
A) A, Rh-positive O, Rh-positive
B) A, Rh-positive O, Rh-negative
C) A, Rh-negative O, Rh-negative
D) O, Rh-positive O, Rh-negative
E) O, Rh-negative O, Rh-positive

[ArchivalUser]

e.

[ArchivalUser]

Answer:

...........Mother ..............Newborn

E) O, Rh-negative O, Rh-positive



Rh ISOIMMUNIZATION

In this condition, fetal RBCs leak into the maternal circulation, and maternal anti-Rh IgG antibodies form that can cross the placenta, leading to hemolysis of fetal Rh RBCs (erythroblastosis fetalis). There is an risk among an Rh- women who have had a previous SAB or TAB (TAB: Therapeutic Abortion; SAB: Spontaneous Abortion) as well as among those who have undergone a previous delivery with No RhoGAM given.


DIAGNOSIS
Sensitized Rh- mothers with titers > 1:16 should be closely monitored with serial ultrasound and amniocentesis for evidence of fetal hemolysis.

TREATMENT
In severe cases, initiate preterm delivery when fetal lungs are mature. Prior to delivery, intrauterine blood transfusions may be given to correct a low fetal hematocrit.

PREVENTION

If the mother is Rh(-) at 28 weeks and the father is Rh(+) or unknown, give RhoGAM (Rh immune globulin).

If the baby is Rh(+) , give the mother RhoGAM postpartum.

Give RhoGAM to Rh(-) mothers who undergo abortion or who have had an ectopic pregnancy, amniocentesis, vaginal bleeding, or placenta previa/placental abruption.

Type and screen is critical; follow β-hCG closely and prevent pregnancy for 1 year.

COMPLICATIONS
Hydrops fetalis when fetal hemoglobin is < 7 g/dL. Look at the pale baby with Anasarca, hepato-splenomegaly, Coombs test positive. This means that Fetal RBC are being destroyed.
Fetal hypoxia and acidosis, kernicterus, prematurity, death.

[ArchivalUser]

you ae doing geat and you will be geat at your exam I am sure of it waiting for the next q)