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Rh Incompatibility

• Mother is Rh (-) and baby is Rh (+). Mother has potential to create anti Rh (+) antibodies.
  RBC’s do not cross the placenta, but IgG antibodies do.
• There must be a traumatic event when the fetus’s blood comes in contact with the mother’s blood to trigger antibody production.
• Uterine trauma
• Amniocentesis
• Delivery
• Untreated outcomes range from mild anemia to stillbirth

Labs & Studies

• Indirect Coombs test is used to test mom’s antibody production if she is Rh negative
• Direct Coombs test can be be used to test if the fetal RBC’s have antibodies attached to them.
• Antibody titers
• Fetal CBC and Hgb
• Fetal U/S
• Fetal bilirubin

##Treatment##
– RhoGAM is RH IgG that is administered IM at 28 weeks gestation.
– RhoGAM is also recommend within 72 hours of a traumatic event like delivery
– Intrauterine blood transfusion
– Early delivery

Multiple Gestations

An increasing factor with current infertility methods

Complications

• Preterm birth
• HTN
• Fetal growth restriction
• Cord problems
• Congenital abnormalities
• Placenta abruption
• Placenta previa

Labs & Studies

• U/S is used to diagnose and monitor the pregnancy

Preeclamspia and Eclampsia

Preeclampsia is a combination of proteinuria and elevated blood pressure in the late 2nd or 3rd trimester that is a precursor for ecclampsia. Ecclampsia is characterized as seizures in a pregnant women with no preexisting disorder.

Risk factors

• First pregnancy
• Multiple gestation
• Obesity
• Advanced maternal age, worse after 40
• History of DM, HTN or kidney disease
• Teenage pregnancy
• African American heritage

Clinical Characteristics

• Decreased urine output < 500ml/24hr – Severe headaches – Nausea and vomiting – Right sided abdominal pain – Changes in vision – Significant swelling of the hands, feet and face – Pulmonary edema – Hyperactive reflexes ## Tests and Labs ## – Urinalysis – proteinuria > 5 g/24hr
• BP greater than 140/90
• Elevated liver enzymes
• Platelet count less than 100,000
• U/S for fetal distress and growth retardation

Complications

Maternal complications

• HELLP syndrome (which may be a variant of eclampsia)
• Hemolysis
• Elevated liver enzymes
• Low platelet count
• Disseminated intravascular coagulation (DIC)
• Cerebral hemorrhage
• Renal failure
• Pulmonary edema
• Hemolysis

Fetal complications

• Preterm delivery
• Low birth weight
• Death

Treatment

• Deliver the baby!
• If before 32 weeks gestation
• Bed rest
• Magnesium sulfate for seizure control
• Antihypertensive
• Beta blocker like Labetalol
• Do not give diuretics in preeclamptic patients
• Do not give ACEI to pregnant women