Assessment and management of issues in early pregnancy

Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and alternative management strategies, including early pregnancy units, are also discussed.

Rhesus Negative Pregnancy: Prevalence and Foetomaternal Outcomes in a Tertiary Hospital, South-South Nigeria

Rhesus incompatibility can pose a problem in pregnancy and cause obstetric failure in a handful of women. The Rhesus factor is a red blood cell surface antigen; and there are many antigen subtypes that make up the Rhesus blood group systems, of which the most commonly involved and most immunogenically associated with Rhesus isoimmunisation is the D antigen. The objective of this study is to determine the prevalence of Rhesus negativity and the foetomaternal outcomes at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria. This was a 5-year retrospective study conducted between 1st January, 2016 and 31st December, 2020 at our Obstetric Unit. Data were retrieved, entered into a pre-designed preformed and analyzed using SPSS version 25.0. Results were presented as mean and standard deviation for continuous variables and frequencies or percentages for categorical variables. Of the 4,571 pregnant women, 104 were Rhesus negative, giving a rate of 2.27%. The most common blood group among the women (53.8%) and their partners (84.6%) was the O blood group. Only 2 (1.9%) women were sensitised. Out of the 104 Rhesus negative women, 81 were unsensitised (77.9%) and received anti-D immunoglobulin. Majority of the babies had a good outcome, though 19 (18.2%) of them were admitted into the special care baby unit for various conditions. The incidence of Rhesus negative pregnancy in our study was 2.27%, and 1.9% of the women were sensitised. Prompt administration of anti-D immunoglobulin after sensitising events and post-delivery is key in the prevention of Rhesus isoimmunisation.

Hydrops fetalis with isolated massive ascites in a preterm neonate with rhesus disease

SummarySignificant progress in prenatal care has decreased the incidence of rhesus incompatibility, which may result in hemolytic disease of the fetus and newborn (HDFN). This case report describes an unusual presentation of HDFN in a preterm infant delivered by caesarean section with isolated massive abdominal fluid collection as the leading clinical sign in addition to severe anemia. The immediate drainage of ascites provided transient clinical stabilization with improved pulmonary function in the delivery suite. After admission to the neonatal intensive care unit (NICU), HDFN treatment was initiated. This case report shows the importance of adequately trained staff including neonatologists, pediatricians and NICU nurses in the delivery suite to provide neonatal intensive care for HDFN.

Rhesus incompatibility in pregnancy: a case report

Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs due to the destruction of red blood cells, which the most common cause is rhesus incompatibility. This study aims to present a case of Rhesus incompatibility in pregnancy without a clinically significant effect on the baby. Case: A-38-years-old Indonesian woman with gravida 4 para 3 (G4P3A0), 32 weeks of gestational age came to the emergency department due to vaginal bleeding. On blood typing, she had an A-negative (A-) blood type. Her husband and all three of their children had O-positive (O+) blood type. The patient underwent a cesarean section due to recurrent antepartum hemorrhage following the total placenta previa. She gave birth to a baby girl, weighed 2,220 grams with an A-positive blood type. The hemoglobin level was 14.6 g/dL without any sign of neonatal jaundice during the first 24 hours of life. Conclusion: Our case illustrates a woman who did not show any sign of clinically Rhesus antigen alloimmunization. Low immunogenicity and dose-dependent response to a low fetal blood volume exposure might explain this phenomenon.

Hematopoietic Recovery after in-Vivo T-Cell Depleted Allogeneic Stem Cell Transplant- Effects of ABO Incompatibility, Rhesus Incompatibility and Acute Gvhd

Background: Transfusion needs after allogeneic transplantation are closely associated with morbidity, cost of transplantation and may also be associated with long-term outcome. In an effort to better predict determinants of recovery after reduced intensity conditioning, we analyzed 214 consecutive patients who received allogeneic hematopoietic stem cell transplantation (HSCT) at our institution from January 2012 to December 2013. Patients and Methods: We excluded patients who experienced early (in the first 4 months) relapse (n=28), non-relapse mortality (n=28) or who experienced prolonged hospital stay before day 100 for transplant related complications (n=51). One hundred and seven patients had uneventful recovery until day 100 and met the inclusion criteria. The majority of patients received Fludarabine and melphalan conditioning (87%). Approximately one third each of the patients had HLA-identical related, HLA-matched unrelated donors or underwent haplo-cord transplantation. Recipients of HLA-identical related or unrelated donor transplant received alemtuzumab and post-transplant tacrolimus. Haplo-cord recipients received thymoglobulin and post-transplant tacrolimus and mycophenolate. Patients and transplant characteristics are summarized in table 1. T-tests were used for comparison between groups. Results: In our analysis of 107 patients who underwent T cell depleted allogeneic transplantation and fared well at day 100, the determinants of prolonged anemia were ABO incompatibility (p=0.006), rhesus incompatibility (p=0.01) and acute graft versus host disease (aGVHD) (p=0.02). Whereas prolonged thrombocytopenia was only associated with the development of any grade aGVHD (p=0.04). At day 100, the hematopoietic recovery of haplo-cord grafts is similar to matched related and unrelated grafts. Conclusion: ABO incompatibility, rhesus incompatibility and occurrence of acute graft vs host disease are the major determinants of red blood cell recovery. Occurrence of acute graft vs host disease is a major determinant of platelet recovery. Of interest, the use of umbilical cord blood grafts combined with haplo-identical grafts is associated with recovery of red blood cells and platelets that is similar to that of adult donor grafts. Disclosures No relevant conflicts of interest to declare.

Rhesus incompatibility in a four-day-old infant

This paper reports the first case of Rh-incom-patibility in newborns found at our hospital.

Rhesus Disease in Pregnancy

Rhesus incompatibility between mother and foetus can, if undetected and untreated, lead to Rhesus disease of the newborn: a haemolytic state which can be fatal. Screening in pregnancy allows routine prevention of Rhesus disease. Post-delivery administration of anti-D immunoglobulin to Rhesus-negative women began in the UK in 1969. As a result, the deaths attributed to RhD alloimmunization fell from 46/100 000 births before 1969 to 1.6/100000 in 1990. However, antenatal procedures and presentations commonly encountered in primary care may cause the exposure of a Rhesus-negative mother to Rhesus antigens. Awareness of Rhesus disease in routine and emergency antenatal care is therefore essential.