EBCOG PART 1 – ANTENATAL CARE – DAY 3 (SBA)

1.You are about to see Barbara Adams , a 32 year old computer programmer in postnatal ward She suffered a still birth at 40 weeks Few hrs before She delivered yesterday fresh still born female baby weighing 2.2kg at 8.30 pm Her pregnancy was low risk so far .her blood group is AB Rh negative ,Kleihauer-Betke test done it shows 6ml .if she has to receive intramuscular AntiD,what’s the dose ?

2. Ms. Angel, 34 year old p0+4 has come at 34 weeks gestation with absent fetal movements since yesterday .her blood group is A Rh negative . She has always taken her anti D before for all her miscarriages and she is non sensitised, scan done shows absent fetal movements

3.MRs.Andrews At 34 weeks gestation in her second pregnancy She had previous cesarean section.repeat scan today in antenatal clinic confirms grade 4anterior placenta Previ.Mri has ruled out accreta. She understands she need cesarean section .She is a jehovah witness and doesn’t want blood transfusion.She has signed advance directive.Her blood group is B Rh Negative and she is non sensitised .During the cesarean section she needed this procedure as shown in image as she had major PPH.

what the dose of ANTI D needs to be given ?

4. Following potentially sensitising events in preganncy , anti-D Ig should be

5. You are asked to see a 21-year-old para 1 in the early pregnancy assessment unit. She is 9 weeks into her second pregnancy and presents with cramping abdominal pain and vaginal bleeding. Pelvic ultrasound scan shows a picture of incomplete miscarriage. She opts for surgical management of the miscarriage, and you consent her for surgical evacuation.her blood group is ORh negativeWhat’s the best advise ?

6. You are asked to see a 21-year-old para 1 in the early pregnancy assessment unit. She is 9weeks into her second pregnancy and presents with cramping abdominal pain and vaginal bleeding. Pelvic ultrasound scan shows

7. All Non- sensitised Rhesus (Rh) negative women should receive prophylactic anti-D Immunoglobulin (Ig) in the following situations except

8. Regarding Administration of routine antenatal anti-D Ig prophylaxis (RAADP),

9. You are about to see Barbara Adams , a 32 year old computer programmer.primigravida pregnancy complicated by Placenta previa .she is now 30weeks into her pregnancy presenting with mild bleeding ,she had received routine antenatal anti-D Ig prophylaxis at 28 weeks .What’s the best advice regarding her AntiD

10. Which of the statements regarding FMH is true?

11. MRs.Andrews At 34 weeks gestation in her second pregnancy She had previous cesarean section.repeat scan today in antenatal clinic confirms grade 4anterior placenta Previ.Mri has ruled out accreta. She understands she need cesarean section .She is a jehovah witness and doesn’t want blood transfusion.She has signed advance directive .Her blood group is B Rh Negative and she is non sensitised During the cesarean section she needed intraoperative cell salvage ..what’s the maximum volume of fetal red cells in re-infused blood possible ?

12.Ms. Suzy, 19 year old G2 P1 who had been previously a well was referred from a peripheral hospital at 28 weeks gestation with anaemia (Hb 6.8) and marked thrombocytopenia (PLT17).At presentation she was complaining of headache and lethargy Examination revealed her to be normotensive, afebrile, to have no focal neurological signs and no proteinuria. The fundus height was appropriate for dates and the foetus viable.Investigation revealed severe red cell fragmentation and polychromasia, in association with anormal clotting profile, normal renal function, normal liver function and negative Coomb’s test.She was initially treated with prednisolone, blood and platelets but detriorated and it was at this stage that a diagnosis of TTP was considered most likely.As her platelet fell down to 30×10 9/L, her blood group is ARh negative she needed platelet transfusion , since same wasn’t avialble, she was transfused A Rh positive platelets 5doses What’s true regarding AntiD ?

13. Free fetal DNA a an diagnose fetal blood grouping &Rh typing with accuracy of

14.Mr&mrs, ,Admas has been involved in a road traffic accident at 29 weeks of gestation without any vaginal bleeding but with trauma to the abdomen.It’s her first pregnancy .Het blood group is AB Rh negative She had received routine antenatal prophylaxis with 1500 units at 28 weeks. What is the most appropriate management?

15.Mr&mrs, ,Mishra has been involved in a road traffic accident at 29 weeks of gestationwithout any vaginal bleeding but with trauma to the abdomen.It’s her second pregnancy pregnancy .her blood group is O Rh negativeShe has anti-D levels of 4 IU/ml has an antepartum haemorrhage at 24 weeks of gestation.What is the most appropriate management with regards to anti-D?

16. Mrs, alisha p+3 is known to have anti-K antibodies. She is now at 22 weeks of gestation.What is the best management to investigate if anaemia is present in the fetus?

17.Ms. Mariadumba, asylum seeker , late booker At 24 weeks , she says she has taken blood transfusion before . Usg image s enclosed, you suspect alloimmunization.What are the chances of this fetus

18. MsTina A 23 year old Rh-D negative patient attends EPU after 2 hours of light menstrual bleeding that has now resolved. Ultrasound 

19. A 26 year old Rh-D negative patient presents with PV bleeding at 22 weeks gestation and miscarriage is diagnosed. Kleihauer-Betke test shows feto-maternal haemorrhage volume at 2.5ml.

20.Which of the statements regarding FMH is true?

21.Haemolytic disease of the fetus and newborn (HDFN) is a condition in which transplacental passage of maternal ———antibodies

22.  which is the most commonly encountered antibody during pregnancy

23.What is the prevalence of clinically significant antibodies in pregnancy ?

24. Antibodies to many of the red cell antigens have the potential to be clinically significant andwill have implications for the selection of blood for transfusion in the mother to avoid the risk of haemolytic transfusion reactions (HTRs).All women should have their blood group and antibody status determined

25. The risk of fetal anaemia is greatest with

26.Mrs. Susan A 25-year-old women who is 10 weeks pregnant has anti-D antibodies in her booking bloods.she gives history of blood transfusion due to RTA .What is the reliable method available at this gestation to determine the fetal RhD antigen status?

27.You are teaching junior colleagues about red cell antibodies and their effect on fetus .One of them ask u RH antigen gene is Carried on which chromosome ?

28.Ms. Mariadumba, asylum seeker , late booker at 14 weeks , she says her previous pregnancy was complicated by Anti-kell antibodies .she asks you regarding Fetal genotype got as she read from Internet ,you advise her to do these tests

29. Referral to a fetal medicine specialist should occur in all of the follwing expect

30. Not all antigens are expressed in the early months of fetal life. Rhesus antigens are well expressed by ——-of gestation, unlike the ABO antigen system which is only weakly expressed in fetal life.

31. A 31-year-old nulliparous women who is 16 weeks pregnant. At her booking bloods she was found to be O RhD negative with anti-c antibodies. The anti-c level is reported as 5 IU/ml.

32. Sensitivity of this method to identify severe fetal anemia is

33. False positive rate of this method to identify severe fetal anemia is

34. For fetal transfusion in fetal anemia secondary to alloimunsation

35. A 31-year-old nulliparous women who is 34 weeks pregnant. At her booking bloods she was found to be O RhD negative with anti-c antibodies,she is going for elective cesarean section for major placenta previa .idealy should have a cross-match sample taken at least

36. Blood for neonatal small volume (‘top-up’) transfusion

37. Cord blood investigations should be undertaken in addition to ABO and RhD typing wherethe mother is known to have immune red cell antibodies. Whcih of the following techniques are used?

38. Which type of deafness is common in haemolytic anemia babies secondary to alloimmunisation ?