The following is a case study of a female Jane, a multiparous, gravida two, parity one, 30 year-old woman who has recently moved from rural Africa to Australia at 36 weeks gestation into her pregnancy. Jane has a rhesus negative blood type and the concern for Jane and her baby is how the incompatibility of the rhesus factors in each of their blood and what this may cause after giving birth to a Rhesus positive first child in rural Africa 3 years ago. Rhesus negative blood is a minority blood group common in between 12-18% of European, North American and Australian Caucasians and only 2-5% of Janes’ African heritage are Rhesus negative. (SA Maternal and Neonatal Clinical Network 2010). The implication of rhesus negative blood is when the fetus …show more content…
(Collins. S, et al. 2013). The Rhesus factor is a blood group protein attached to red blood cells and its presence is jointly determined from maternal and paternal genes (CSL Bioplasma 2006). Of all, the rhesus’, D factor is considered to have the most concern in possible impaired outcomes due to an incompatibility of bloods. In relation to this case study, The Rhesus incompatibility is of concern between Jane and her fetus where Jane is negative for the Rhesus D antigen whilst her baby was positive, it cannot be confirmed for sure whether her current fetus will be positive for the rhesus d antigen without knowing her partners rhesus d blood genotype. It is known that Jane’s fetus has rhesus antigens present on its RBCs due to that …show more content…
Any event during her pregnancy, labour or birth that may lead to the mixing of maternal and fetal blood, also known as sensitising events, This event has many repercussions for the fetus including anaemia due to the destruction of RBCs, Haemolytic disease of the newborn (HDN), oedema, congestive heart failure, neurological damage, jaundice due to increased levels of bilirubin, kernicterus, hydrops fetalia, ictarus gravis neonatorum, fetal death interutero and stillbirth. (Collins. S et al. 2013; Stables. D & Rankin. J 2014).
Hemolytic Disease of the newborn (HDN) is the most severe and common implication of rhesus D iso-immunisation, which could be a reality for Jane’s 36-week-old fetus (SA Maternal and Neonatal Clinical Network 2010). HDN arises in a rhesus positive fetus of a rhesus negative mother, where the mother produces antibodies that destroy the red blood cells of the fetus as they are recognized are foreign (Antonios. N 2011). This causes the baby to become sick is called erythroblastosis fetalis during pregnancy and known as hemolytic disease of the newborn after birth (Dean. L
Eden, Elizabeth. "HowStuffWorks "Pregnancy Complications in Older Mothers" HowStuffWorks. N.p., 16 Nov. 2006. Web. 11 Apr. 2014.
Thrombocytopenia affects 6% to 10% of all pregnant women and, other than anemia, is the most common hematologic disorder in pregnancy (McCrae, 2010). Blood consists of three main ingredients: red blood cells, white blood cells, and platelets. Each plays an essential function to provide the human body with elements and protects the body against any exterior viruses and infections. Platelets are responsible for helping blood to clot. A deficiency or disorder of platelets leads to a disease called Thrombocytopenia.
An Rh factor is a protein on the surface of red blood cells. Rh incompatibility happens when a mother has Rh-negative blood and her baby has Rh-positive blood. During pregnancy or delivery, blood from the baby can cross into the mother’s bloodstream. If a mother is Rh-negative and the baby is Rh-positive, the mother’s antibodies can destroy the baby 's red blood cells.
Rett syndrome is a postnatal neurodevelopmental disorder that mainly affects girls but is rarely found in boys as well. Rett syndrome strikes all racial and ethnic groups, and occurs worldwide in 1 of every 10,000 female births. It was first identified by Dr. Andreas Rett, an Austrian physician who described it in an article published in 1966. Even though Rett described the disorder in his 1966 article it went another 17 years until being generally recognized after Swedish researcher Dr. Bengt Hagberg published an article about the disorder in 1983 (Rett Syndrome Fact Sheet).
These women could anticipate delays in normal growth and development for the fetus. The exact cause of post term pregnancy is unknown. The mother experiencing post term pregnancy is at risk for trauma, hemorrhage, infection, and labor abnormalities (Ward et al., 2016, p. 543). Labor induction prior to 42 weeks’ gestation prevents MAS and other complications. A biophysical profile measuring the heart rate, breathing and body movements, tone, and the amniotic fluid volume is used to monitor the fetus for intrapartum fetal stress that could cause passage of meconium. Diabetic woman is at high risk for preeclampsia or eclampsia, infection, hydramnios, postpartum hemorrhage, and cesarean birth (Ward et al., 2016, p. 383). In addition, fetal macrosomia prolongs labor due to shoulder dystocia. The glucose challenge test, and the 3- hour OGTT is used for gestational diabetes screening, done after 24 weeks of pregnancy. Abnormalities of the respiratory system as explained earlier are the most concerning complication of MAS, needing immediate
According to Lucile Packard Children’s Hospital, “In the United States, nearly thirteen percent of babies are born preterm, and many of these babies also have a low birth weight.” The baby may be put into the NICU for varies reasons. However, the most common reason that a child is put into the NICU is because he or she is premature. Premature means the baby was born before the 36 weeks. It is never good for a baby to be born early, as this could mean that the baby is not fully developed. There are other factors as to why a child may need to be put into the NICU after birth. For instance, birth defects can be the cause of why a baby is put into the NICU. A baby may be born with an infection such as herpes or chlamydia which can damage the newborns immune system at such a young age. Low blood sugar or hypoglycemia can also cause an infant to be put into the NICU. Some maternal factors of why a baby may be put into the NICU is if the mother is “younger than 16 or older than 40.” If the parent may be an alcoholic or expose the baby to drugs, this can put the child into NICU care. If the parent has an STD or sexual transmitted disease, the baby is most likely going to have to be put into the intensive care unit. “Twins, triplets, and other multiples are often admitted into the NICU, as they tend to be born earlier and s...
Maternal & Child Health Journal, 8(3), 107-110. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=14089739&site=ehost-live.
17. American College of Medical Genetics Clinical Practice Committee. Statement on multiple marker screening in pregnant women. American College of Medical Genetics College Newsletter, January 1996;6.
Postpartum hemorrhage is the leading cause of maternal mortality in the world, according to the World Health Organization. Postpartum hemorrhage (PPH) is generally defined as a blood loss of more than 500 mL after a vaginal birth, more than 1000 mL after a cesarean section, and a ten percent decrease in hematocrit levels from pre to post birth measurements (Ward & Hisley, 2011). An early hemorrhage occurs within 24 hours of birth, with the greatest risk in the first four hours. A late hemorrhage happens after 24 hours of birth but less than six weeks after birth. Uterine atony—failure for the uterine myometrium to contract—is the most common postpartum hemorrhage (Venes, Ed.).(2013). Other etiologies include lower genital tract lacerations, uterine inversion, retained products of conception and bleeding disorders (Kawamura, Kondoh, Hamanishi, Kawasaki, & Fujita, (2014).
One of the primary prevention methods in maternal health is the utilization of prenatal care. During the provision of prenatal care, a healthcare provider counsels and discusses information with the expecting mother. Conversations about smoking and alcohol use, what to expect during pregnancy, when to seek help, and limitations on activities are put in place (Kirkham, Harris, & Grzybowski, 2005). Discussions about possible complications and potential warning signs are also an important part of prenatal education. Providing supplements, such as, calcium (1,000 to 1,300 mg per day), folic acid (0.4 to 0.8 mg), and iron (30 mg per day) to an expecting mother is also an important part of primary prevention, as they aid in the fight against blood pressure disorders, anemias, and defects in the unborn child (Kirkham, Harris, & Grzybowski, 2005). Additionally, the vaccination of expecting mothers has been shown to keep mothers and the unborn child healthy during pregnancy. Certain vaccinations, such as Tdap (tetanus, diphtheria, and pertussis) and inactivated influenza vaccinations, have been shown to be protective to the fetus, as the mother’s antibodies against the disease are transferred to the unborn child (Esposito et al., 2012).
Prenatal genetic screening in particular is a polarizing topic of discussion, more specifically, preimplantation genetic diagnosis (PGD). PGD is one of the two techniques commonly used to genetically screen embryos in vitro; it is usually done at the eight-cell stage of division. PGD is most often performed when there is the risk that one or both parents carry disease-causing mutations. It is extensively used by high-risk individuals trying to conceive babes who will be free of particular mutations. PGD can test for over 50 genetic conditions and even allows for sex selection if there are underlying gender-associated medical conditions. When the results are satisfactory, the selected embryo is implanted into the mother’s uterus. While a controversial technique, preimplantation genetic diagnosis is one example of some of the good genetic testing can do, more benefits will be furthe...
Thus the reason fetal monitoring is important in the case of
Sepsis is a “cunning, insidious and non-specific illness” (Raynor, 2012) but progression can be rapturous with a sudden catastrophic circulatory collapse and mortality up to 50%. (Angus et al., 2001) Over five million cases arise per year of maternal sepsis, resulting in an estimated 62,000 maternal deaths globally (WHO, 2008) During the 18th and 19th century, puerperal sepsis resulted in 50% of maternal deaths over Europe (Loudon, 2000). The World Health Organisation (WHO) defined puerperal sepsis as ‘infection of the genital tract occurring at any time between the rupture of membranes or labour, and the 42nd day postpartum, of which two or more of the following are present: pelvic pain, fever 38.5C or more, abnormal vaginal discharge, abnormal smell of discharge, and delay in the rate of reduction of size of uterus (less than 2 cm a day during the first 8 days)’ (WHO, 1992).
Every woman when pregnant has a 3-5% chance of having a baby born with a birth defect, and these chances increase when the developing fetus/ embryos are exposed to teratogens, whether it’s intentional or unintentional (Bethesda (MD), 2006). Teratogens can cause severe birth defects, malformations, or terminate the pregnancy altogether (Jancárková, & Gregor, 2000). The placenta is known as an effective barrier from any detrimental pathogen that can potentially hurt the fetus. The timing of exposure of any teratogen is critical to the impact of prenatal development (Bethesda (MD), 2006). The most vulnerable time of the fetus for severe damage is during early pregnancy when all the major organ and central nervous system (CNS) are developing. Miscarriages have an important role in keeping a pregnancy from evolving when there is something serious going on with the developing fetus/embryo. Miscarriages are more common than we think and are the most familiar type of pregnancy loss (Bethesda (MD), 2006).
As noted earlier, the field of maternal-fetal medicine is one of the most rapidly evolving fields in medicine especially when it concerns the fetus. Research is being done in the field of fetal gene and stem cell therapy in hopes of providing early treatment for genetic disorders (Abi-Nader et.al, 2009). Research is also been done for open fetal surgery for the correction of birth defects like congenital heart disease, and the prevention of pre-eclampsia.