prenatal care/rh disease

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Question 1 / 3

683d0c22c1b3f4bd827da665

Obstetrics

prenatal care

rh disease

Case History

A 26-year-old G1P0 female at 30 weeks gestation presents to her obstetrician's clinic for a routine antenatal visit. During history taking, she casually mentions experiencing transient, light vaginal spotting earlier that morning, which has since resolved. She denies any associated abdominal cramping, uterine contractions, or significant pain. Fetal movements are reported as normal and active. Her initial prenatal labs at 10 weeks gestation indicated a Rh-negative blood type, and her indirect Coombs test was negative at that time. Given this new report of even minor bleeding, what would be the most appropriate next step in her evaluation and management to prevent potential complications?

Lab Parameter	Value	Reference Range
Maternal Blood Type	O Rh-negative	O Rh-positive or Rh-negative
Indirect Coombs Test	Negative	Negative
Hemoglobin	128 g/L	120-150 g/L
Hematocrit	0.38	0.35-0.45

A ) Perform a Kleihauer-Betke test to quantify feto-maternal hemorrhage and if indicated, administer anti-D immunoglobulin to prevent alloimmunization.

B ) Reassure the patient that isolated mild spotting is common in pregnancy and advise close monitoring for further bleeding without further intervention.

C ) Administer immediate IV tranexamic acid to prevent further bleeding and schedule a follow-up ultrasound in one week to assess placental integrity.

D ) Order a complete coagulation panel and prepare for blood product transfusion, as any vaginal bleeding in the third trimester necessitates immediate hemorrhage management.

E ) Since the indirect Coombs test was negative initially, no further action is required regarding Rh prophylaxis, as sensitization is unlikely at this gestational age.

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Question 2 / 3

683d0c22c1b3f4bd827da666

Obstetrics

prenatal care

rh disease

Case History

A 28-year-old G1P0 at 36 weeks gestation presents to the antenatal clinic for pre-procedure evaluation for an external cephalic version (ECV) due to a persistent breech presentation. Her prenatal course has been generally uncomplicated, though she was noted to be Rh-negative early in pregnancy with no detectable anti-D antibodies. She is otherwise healthy, with no significant past medical history. Physical examination reveals a fundal height consistent with gestational age and a firm, ballotable fetal head in the fundus. Fetal heart tones are reassuring, and a bedside ultrasound confirms the breech presentation. Given her Rh status and the upcoming procedure, what immediate prophylactic measure should be undertaken, and what serious complication is this measure designed to avert?

Lab Parameter	Value	Reference Range
Hemoglobin	125 g/L	120-160 g/L
White Blood Cell Count	8.5 x 10^9/L	4.0-10.0 x 10^9/L
Platelets	250 x 10^9/L	150-450 x 10^9/L
Indirect Coombs Test	Negative	Negative

A ) Kleihauer-Betke test and close monitoring for placental abruption

B ) Complete blood count and assessment for disseminated intravascular coagulation

C ) Rhogam (anti-D immune globulin) administration and monitoring for fetal hydrops

D ) Repeat indirect Coombs test and preparation for potential preterm labor

E ) Urinalysis for infection and counseling on postpartum contraception

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Question 3 / 3

683d0c22c1b3f4bd827da667

Obstetrics

prenatal care

rh disease

Case History

A 28-year-old woman, gravida 2 para 1, presents to her outpatient clinic for a routine prenatal visit at 28 weeks' gestation. Her first pregnancy resulted in a full-term delivery of an Rh-positive infant, after which she received appropriate anti-D immunoglobulin postpartum. She is now pregnant with a new partner. She denies any current acute complaints, vaginal bleeding, or leakage of fluid. Her medical history is unremarkable, and she is taking only prenatal vitamins. Vitals signs show a temperature of 37.0°C, blood pressure of 128/78 mmHg, pulse of 85/min, and respirations of 16/min. Physical examination reveals a fundal height consistent with gestational age. The fetal heart rate is 142/min. Considering her obstetric history and current status, what is the primary immunological risk for this pregnancy and the most appropriate comprehensive management plan to mitigate it?

Lab Parameter	Value	Reference Range
Blood type and Rh(D) status	O negative	Rh(D) positive or negative
Anti-D antibody screen	Negative	Negative
Hemoglobin	128 g/L	110-140 g/L (for pregnant women)
White Blood Cell Count	8.5 x 10^9/L	4.0-10.0 x 10^9/L
Urinalysis	Negative for protein, glucose, nitrites, leukocytes	Negative

A ) Low risk of alloimmunization; recheck anti-D antibody levels at 34 weeks gestation and administer anti-D immunoglobulin only if positive.

B ) Significant risk of Rh alloimmunization; administer anti-D immunoglobulin at 28 weeks gestation and proceed with serial Doppler ultrasound for middle cerebral artery peak systolic velocity (MCA-PSV).

C ) Potential risk of Rh sensitization; administer anti-D immunoglobulin now, with further administration only if the neonate is confirmed Rh-positive at birth.

D ) Primary risk of RhD alloimmunization; administer anti-D immunoglobulin at 28 weeks gestation and within 72 hours of delivery.

E ) Minimal risk of alloimmunization due to prior anti-D administration; no further intervention required unless a sensitizing event occurs.

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