RhoGAM question

[TheDudeabides]

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quick question,
Studying for step II, just read in Crush step 2 "...during prenatal care, check Rh antibodies at 1st visit, if positive, do NOT give RhoGAM-you are too late"
well what then do you do, it does not say? Anyone out there know
Thanks

 

[LADoc00]

quick question,
Studying for step II, just read in Crush step 2 "...during prenatal care, check Rh antibodies at 1st visit, if positive, do NOT give RhoGAM-you are too late"
well what then do you do, it does not say? Anyone out there know
Thanks

Check father's Rh status, check maternal titers over time, check OD of AF and be ready for intra-uterine fetal exchange transfusion if all hell breaks loose.

On a personal side note, 20%!!! 😱 Of all paternity is the US is fradulent (some think it may be as high as 40% if there is any suspicion of infidelity ), thus you cant assume the husband and the father are the same, thus you cant rule out a possible Rh incompat fetus always without further testing. Sad sad state of affairs, but our American housewives are shanks.

As a pathologist, I literally see the very worst in humanity. I sit back with my iPod and PB&Js and soak it all up 🙁

 

[starayamoskva]

quick question,
Studying for step II, just read in Crush step 2 "...during prenatal care, check Rh antibodies at 1st visit, if positive, do NOT give RhoGAM-you are too late"
well what then do you do, it does not say? Anyone out there know
Thanks

Refer the patient to the MFM. They do serial sonograms and check velocities in one of the cerebral arteries (can't remember which one) to detect anemia. If the velocity reaches a certain level then you do an intrauterine stick of the umbilical cord and give transfusion and repeat as necessary.
And don't worry they won't ask you what to do.

 

[TheDudeabides]

Refer the patient to the MFM. They do serial sonograms and check velocities in one of the cerebral arteries (can't remember which one) to detect anemia. If the velocity reaches a certain level then you do an intrauterine stick of the umbilical cord and give transfusion and repeat as necessary.
And don't worry they won't ask you what to do.

I posted the same question in the Steps forum and got the answer I was looking for....--------------------------------------------------------------------------------

Quote:
Originally Posted by Idiopathic
This is, I believe, the Rx of choice. Not advisable to let it get to this situation, however.

Serial amniocentesis are performed @ around 20 weeks if the Rh titer is greater than 1:16. Amniotic fluid is analyzed for bilirubin and this is plotted on a curve which predicts disease severity. When hematocrit falls too low, intrauterine transfusions are done.




ahhh yes...that is starting to sound familiar...thanks, i'm way too lazy and unmotivated now to look those kind of things up on my own



But thanks for the input 🙂

 

[Idiopathic]

Actually, as I was informed by my attending, my way is the 'old school' way, and now they do doppler studies of the MCA and the umbilical vessels, plotting out ratios and what not, to determine if the fetus is shunting blood, as would be expected in early hydrops. So technically they are both right, but stara's method is the 'new school' way.

Still, paternity Rh is checked, followed by titers...that part doesnt change.

BTW, I have been told as many as 10% of all pregnancies have paternity in doubt, and reliable sources say 5-10%. Not sure it is close to 20%.

 

[dankatzzz]

Actually, as I was informed by my attending, my way is the 'old school' way, and now they do doppler studies of the MCA and the umbilical vessels, plotting out ratios and what not, to determine if the fetus is shunting blood, as would be expected in early hydrops. So technically they are both right, but stara's method is the 'new school' way.

Still, paternity Rh is checked, followed by titers...that part doesnt change.

BTW, I have been told as many as 10% of all pregnancies have paternity in doubt, and reliable sources say 5-10%. Not sure it is close to 20%.

Per Williams Obstetrics, the father is not the father in 15% of the cases. In my clinic population I would venture to say more...

As for the Rh status everybody here is on target. The correct board answer is to check the OD450 by doing serial amnios. As was mentioned before, most people use the MCA doppler velocities and when the baby is begining to e anemic it shunts more blood to the brain, thus increasing the MCA doppler velocities. Umbilical artery dopplers are used for following IUGR and are more indicative of placental problems, not anemia. An increase in UA doppler flow is indicative that the placenta is becoming a high resistance organ - it needs to be low resistance. MCA dopplers are not uniformly endorsed and most board questions lag in a few years, so the OD450 (or Leily curve) is more accurate response. The won't have the MCA doplers on the Step II yet.

Dani

 

[Diane L. Evans]

DAni good reply