Disorders

Rh
Sensitizati
on

Risk Factors
Things that
increase the risk
of blood mixing
and sensitization
during pregnancy
include:

Delivery.
Abdominal
trauma, such
as from a car
accident.
Abdominal
surgery, such
as a cesarean
section.
Placenta
abruptio or pla
centa previa,
both of which
can cause
placental
bleeding.
External
cephalic
version for
a breech fetus.
Obstetric
procedures
such
as amniocentes
is, fetal blood
sampling,
or chorionic
villus sampling
(CVS).
Miscarriage (sp
ontaneous abor
tion), ectopic
pregnancy, or
elective
abortion
(medical or
surgical
abortion) after
8 weeks of
fetal age (when
fetal blood cell
production
begins).
Partial molar

Etiology
Fetomaternal hemorrhage
(FMH), which can occur
during pregnancy or
delivery, triggers the Rhnegative mother's
immune system to
develop antibodies
against the antigens in
her baby's Rh-positive
blood. This is called Rhsensitization or
alloimmunization. While
this is the most common
cause for Rh-sensitization,
there are other ways in
which sensitization can
occur. For instance, Rhsensitization occurs when
someone with Rhnegative blood receives a
transfusion of Rh-positive
blood or blood
components, such as
platelets.
Typically, only a small
number of antibodies are
produced in the first
pregnancy. During
delivery, however, the
mother's immune system
becomes sensitized to the
Rh factor. In subsequent
pregnancies, the mother
produces a greater
number of antibodies,
which cross the placenta
to destroy the fetal red
blood cells and create
significant health risks for
the baby. With each
subsequent Rh-positive
pregnancy, the mother's
antibody reaction is
faster, with potentially
more severe
consequences.

Management
If you are already Rhsensitized and are
pregnant, your
treatment will focus on
preventing or
minimizing fetal harm
and on avoiding early
(preterm) delivery.
Treatment options
depend on how well or
poorly the fetus is
doing.

If testing shows that

your fetus is Rhpositive but is only
mildly affected by
your Rh factor
antibodies, you will
be closely watched
until
your pregnancy rea
ches term. Your
fetus will be
delivered early only
if his or her
condition gets
worse.
If testing shows that
your fetus is
moderately affected
by your Rh
antibodies, your
fetus's condition will
be closely watched
until his or
her lungs are
mature enough for
a preterm delivery.
A cesarean
section may be
used to deliver the
baby quickly or to
avoid the difficulty
of inducing
labor before term. A
moderately
affected newborn so
metimes needs a
blood transfusion
immediately after

Picture

pregnancy invo
lving fetal
growth beyond
8 weeks.

Although rare, Rh
sensitization has
been known to
occur after needle
sharing between
intravenous drug
users. Transfusing
Rh-positive blood
in an Rh-negative
person can also
trigger
sensitization. But
this is extremely
rare, because
blood is always
tested prior to
transfusion.

birth.
If testing shows that
your fetus is
severely affected by
your Rh factor
antibodies, a blood
transfusion may be
given before birth
(intrauterine fetal
blood transfusion).
This can be done
through the
fetus's abdomen or
directly into the
fetus's umbilical
cord. A preterm
delivery is likely to
be needed. Multiple
blood transfusions
are sometimes
needed to keep a
fetus healthy until
the fetal lungs
mature enough to
function after birth.
Often a cesarean
section is done to
deliver the baby
quickly. A blood
transfusion is
sometimes needed
immediately after
birth.

If you are unsensitized

Rh-negative, treatment
focuses on preventing
Rh sensitization during
pregnancy
and childbirth. Rh
immune globulin (such
as RhoGAM) is a highly
effective treatment for
preventing
sensitization.

To prevent
sensitization from
occurring late in the
pregnancy or during
delivery, you must
have a shot of Rh

immune globulin
around week 28 of
your pregnancy.
This treatment
prevents your
immune system
from
making antibodies a
gainst your fetus's
Rh-positive
red blood cells.
Rh immune globulin
injection is also
necessary if you
have had
any vaginal
bleeding or an
obstetric procedure
such
as amniocentesis or
external cephalic
version.
If your newborn is
Rh-positive, you are
given Rh immune
globulin again
within 72 hours of
delivery. By
preventing Rh
sensitization from
delivery, you are
protecting your next
Rh-positive fetus.
If your newborn is
Rh-negative,
sensitization cannot
happen, and no
treatment is
needed.

Rh immune globulin is
also needed after
a miscarriage, partial
molar
pregnancy,ectopic
pregnancy, or abortion.
An intrauterine fetal
blood transfusion is
sometimes used to
supply healthy blood to
a fetus with

severe hemolytic
disease of the
newborn (also called Rh
disease or
erythroblastosis fetalis).
A blood transfusion or
exchange transfusion is
sometimes given to
a newborn to treat
severe anemia or jaundi
ce related to Rh
disease.

Anemia/S
moking/Dr
ugs/Alcoh
ol

A diet
lacking in
certain
vitamins. Cho
osing a diet
that is
consistently
low in iron,
vitamin B-12
and folate
increases your
risk of anemia.

Intestinal
disorders. Ha
ving an

When you're pregnant,

you may
develop anemia. When
you have anemia, your
blood doesn't have
enough healthy red blood
cells to carry oxygen to
your tissues and to your
baby.
During pregnancy, your
body produces more
blood to support the
growth of your baby. If
you're not getting enough
iron or certain
other nutrients, your body
might not be able to
produce the amount of
red blood cells it needs to
make this additional
blood.

Choose a vitaminrich diet

Many types of
anemia can't be
prevented. However,
you can help avoid
iron deficiency
anemia and vitamin
deficiency anemias
by choosing a diet
that includes a
variety of vitamins
and nutrients,
including:

foods include beef

intestinal
disorder that
affects the
absorption of
nutrients in
your small

It's normal to have mild

anemia when you are
pregnant. But you may
have more severe anemia
from low iron or vitamin
levels or from other
reasons.

and other meats,

beans, lentils,
iron-fortified
cereals, dark
green leafy
vegetables, and

intestine
such as Crohn's
disease and
celiac disease
puts you at
risk of anemia.

Iron. Iron-rich

Anemia can leave you

feeling tired and weak. If
it is severe but goes
untreated, it can increase
your risk of serious
complications like preterm

dried fruit.

Folate. This
nutrient, and its
synthetic form

Surgical

delivery.

folic acid, can be

removal of or

Cigarette smoking
during pregnancy is
known to be harmful and
can result in increased
spontaneous abortions in
the first trimester,
premature placenta
abruption, preterm
delivery, decreased birth
weight and sudden infant
death syndrome. Infants
born to mothers who
smoke during pregnancy
weigh, on average, 150
300 g less than those
born to mothers who do
not smoke and the risk of
small-for-gestational age
is at least two times as
high among women who
smoke as among women
who do not smoke. The
effects of smoking during
pregnancy on fetal growth
and preterm delivery are
greater for older women.
Long-term smoking may
increase the risk of
placental complications.

found in citrus

surgery to the
parts of your
small intestine
where nutrients
are absorbed
can lead to
nutrient
deficiencies
and anemia.

Menstruat
ion. In general,
women who
haven't
experienced
menopause
have a greater
risk of iron
deficiency
anemia than do
men and
postmenopaus
al women.
That's because
menstruation
causes the loss
of red blood
cells.

Pregnancy
. If you're
pregnant,
you're at an
increased risk
of iron
deficiency

fruits and juices,

bananas, dark
green leafy
vegetables,
legumes, and
fortified breads,
cereals and pasta.

Vitamin B12. This vitamin

is found naturally
in meat and dairy
products. It's also
added to some
cereals and soy
products, such as
soy milk.

Vitamin
C. Foods
containing
vitamin C such
as citrus fruits,
melons and

Maternal alcohol
consumption during
pregnancy may lead to
fetal growth retardation,
malformations,
developmental defects,
and/or spontaneous
abortion (48, 49). The
phrase fetal alcohol
syndrome describes the
simultaneous occurrence
of several birth defects
associated with alcohol
consumption during
pregnancy and consists of

berries help
increase iron
absorption.
Consider genetic
counseling if you
have a family
history of anemia
If you have a family
history of an
inherited anemia,

anemia
because your
iron stores
have to serve
your increased
blood volume
as well as be a
source of
hemoglobin for
your growing
baby.

Chronic
conditions. Fo
r example, if
you have
cancer, kidney
or liver failure,
or another
chronic
condition, you
may be at risk
of anemia of
chronic
disease. These
conditions can
lead to a
shortage of red
blood cells.
Slow, chronic
blood loss from
an ulcer or
other source
within your
body can
deplete your
body's store of
iron, leading to

fetal growth restriction,

central nervous system
impairment and facial
deformities; diagnosis
requires the presence of
all three defects. In one
study, 3033% of women
who drank 2 g alcohol/kg
body weight per day gave
birth to infants with fetal
alcohol syndrome.

such as sickle cell

Lower levels of alcohol

consumption during
pregnancy have also been
associated with adverse
outcomes. Alcohol-related
morbidity among infants
who do not meet the
criteria for fetal alcohol
syndrome is referred to as
fetal alcohol effects and
includes a wide variety of
complications from facial
anomalies to
neurodevelopmental
delay.

Anemia treatment

More than 50% of

pregnant women take
prescription or
nonprescription (over-thecounter) drugs or use
social drugs (such as
tobacco and alcohol) or
illicit drugs at some time
during pregnancy, and
use of drugs during
pregnancy is increasing.
In general, drugs should
not be used during
pregnancy unless
absolutely necessary
because many can harm
the fetus. About 2 to 3%
of all birth defects result
from drugs that are taken
to treat a disorder or
symptom.
Sometimes drugs are
essential for the health of

anemia or
thalassemia, talk to
your doctor and
possibly a genetic
counselor about your
risk and what risks
you may pass on to
your children.

depends on the
cause.

Iron
deficiency
anemia. This
form of anemia is
treated with
changes in your
diet and iron
supplements.
If the underlying
cause of iron
deficiency is loss
of blood other
than from
menstruation
the source of the
bleeding must be
located and
stopped. This may
involve surgery.

Vitamin
deficiency
anemias. Folic
acid and vitamin
C deficiency

iron deficiency
anemia.

the pregnant woman and

the fetus.

anemias are
treated with

Family

dietary

history. If your

supplements and

family has a

increasing these

history of an

nutrients in your

inherited

diet. If your

anemia, such

digestive system

as sickle cell

has trouble

anemia, you

absorbing vitamin

also may be at

B-12 from the

increased risk

food you eat, you

of the

may receive

condition.

vitamin B-12
injections.

Other
factors. A

Anemia of

history of

chronic

certain

disease. There's

infections,

no specific

blood diseases

treatment for this

and

type of anemia.

autoimmune

Doctors focus on

disorders,

treating the

alcoholism,

underlying

exposure to

disease. If

toxic

symptoms

chemicals, and

become severe, a

the use of

blood transfusion

some

or injections of

medications

synthetic

can affect red

erythropoietin, a

blood cell

hormone normally

production and

produced by your

lead to anemia.

kidneys, may help

stimulate red
blood cell
production and

ease fatigue.

Aplastic
anemia. Treatme
nt for this anemia
may include blood
transfusions to
boost levels of red
blood cells. You
may need a bone
marrow transplant
if your bone
marrow is
diseased and
can't make
healthy blood
cells.

Anemias
associated with
bone marrow
disease. Treatme
nt of these
various diseases
can include
simple
medication,
chemotherapy or
bone marrow
transplantation.

Hemolytic
anemias. Managi
ng hemolytic
anemias includes
avoiding suspect
medications,
treating related
infections and

taking drugs that

suppress your
immune system,
which may be
attacking your red
blood cells.
Depending on the
severity of your
anemia, a blood
transfusion or
plasmapheresis
may be
necessary.
Plasmapheresis is
a type of bloodfiltering
procedure. In
certain cases,
removal of the
spleen can be
helpful.

Sickle cell
anemia. Treatme
nt for this anemia
may include the
administration of
oxygen, painrelieving drugs,
and oral and
intravenous fluids
to reduce pain
and prevent
complications.
Doctors also may
recommend blood
transfusions, folic
acid supplements

and antibiotics.
A bone marrow
transplant may be
an effective
treatment in
some
circumstances. A
cancer drug
called
hydroxyurea
(Droxia, Hydrea)
also is used to
treat sickle cell
anemia.

Thalassemia.
This anemia may
be treated with
blood
transfusions, folic
acid supplements,
removal of the
spleen
(splenectomy), a
bone marrow
transplant or a
another drug.

Hypereme
sis
Gravidaru
m

The exact cause of

HG is unknown.
Like morning
sickness, a few
factors are likely to
be involved,
including hormonal
changes. Some
women are more
likely to get HG
than others.
You may be more

Hyperemesis gravidarum
is extreme, persistent
nausea and vomiting
during pregnancy. It can
lead todehydration,
weight loss, and
electrolyte imbalances.
Hyperemesis gravidarum
(HG) means excessive
vomiting in pregnancy. HG
is not a common
pregnancy condition. It

There are steps you

can take to help
lessen, and cope
with, the symptoms
of HG:

Talk to your
doctor or midwife
early on and
explain how bad
you are feeling,
and that you'd

likely to develop
HG if:
You're
expecting your
first baby.
You're
expecting a
girl.
You're
expecting twins
or triplets.
Your sister or
mum had HG
during their
pregnancies.
You suffered
from HG in a
past
pregnancy.
You have a
history of
nausea when
using
oestrogenbased hormona
l
contraceptives.
You're prone
to travel
sickness or mig
raines.
You
were overweig
ht at the start
of pregnancy.

You're young.

affects about one in 100

mums-to-be. If you're
suffering from HG, you'll
probably find you struggle
to keep anything down.
HG usually begins
between four
weeks and seven weeks,
easing off from about 15
weeks of your pregnancy.
In most cases, HG will end
by the time you're
about 20 weeks pregnant.
Unfortunately, for some
women, it does not go
away completely until the
end of pregnancy.

like treatment.
Ask your partner,
family and friends
for support and
help with cooking,
shopping,
childcare and
household tasks.
Accept
your cravings for
certain foods and
avoid sights and
smells that trigger
your nausea. If
cooking smells
make you feel
sick, try eating
only cold foods.
Stay hydrated by
taking small sips
of fluid, or by
sucking ice cubes.
Eat whatever you
can manage little
and often, and
dont worry about
what you're
eating. You can
catch up on good
nutrition later, as
your baby will get
her nourishment
from your bodys
reserves.
Get as much rest
as you can.
Tiredness can
make nausea and
vomiting worse.
Don't feel guilty
about how you
feel. You are ill
and it is
absolutely not
your fault.
Talk to others who
know how you
feel in

our community.
Ectopic
Pregnancy

One cause of an
ectopic pregnancy
is a damaged
fallopian tube that
doesn't let a
fertilized egg into
your uterus, so it
implants in the
fallopian tube or
somewhere else.

In a normal pregnancy,
your ovary releases an
egg into your fallopian
tube. If the egg meets
with a sperm, the
fertilized egg moves into
your uterus to attach to
its lining and continues to
grow for the next 9
months.

If the doctor suspects

that the fallopian
tube has ruptured,
emergency surgery is
necessary to stop the
bleeding. In some
cases, the fallopian
tube and ovary may
be damaged and will
have to be removed.

You might not ever

know what caused
an ectopic
pregnancy. But you
are higher risk if
you have:

But in up to 1 of every 50
pregnancies, the fertilized
egg stays in your fallopian
tube. In that case, it's
called an ectopic
pregnancy or a tubal
pregnancy. In rare cases,
the fertilized egg attaches
to one of your ovaries,
another organ in
your abdomen, the cornua
(or horn) of the uterus or
even the cervix. In any
case, instead of
celebrating your
pregnancy, you find your
life is in danger. Ectopic
pregnancies require
emergency treatment.

If the fallopian tube

has not ruptured and
the pregnancy has
not progressed very
far, laparoscopic
surgery may be all
that is needed to
remove the embryo
and repair the
damage. A
laparoscope is a thin,
flexible instrument
inserted through
small incisions in the
abdomen. During this
surgery, a tiny
incision is made in
the fallopian tube and
the embryo is
removed, preserving
the fallopian tubes
integrity.

Current use of
an intrauterine
device (IUD), a
form of birth
control.
History
of pelvic
inflammatory
disease (PID)
Sexuallytransmitted
diseases such
as chlamydia a
nd gonorrhea
Congenital
abnormality
(problem
present at
birth) of the
fallopian tube
History of
pelvic surgery
(because
scarring may
block the
fertilized egg
from leaving
the fallopian
tube)
History of
ectopic
pregnancy

Most often, ectopic

pregnancy happens within
the first few weeks of
pregnancy. You might not
even know you're
pregnant yet, so it can be
a big shock. Doctors
usually discover it by the
8th week of pregnancy.
Ectopic pregnancies can
be scary and sad. The
baby probably can't
survive -- though in
extremely rare cases he
or she might. (This is not
possible in a tubal
pregnancy, cornual or
cervical ) So it's a loss
that may take some time

In some
cases, medication ma
y be used to stop the
growth of pregnancy
tissue. This treatment
option may be
appropriate if the
tube is not ruptured
and the pregnancy
has not progressed
very far.
After medical
treatment for an
ectopic pregnancy,
you will usually have
to have

Unsuccessful tu
bal
ligation (surgic
al sterilization)
or tubal
ligation
reversal
Use of fertility
drugs
Infertility
treatments suc
h as in vitro
fertilization (IV
F).
Inflammation
or
infection. Infla
mmation of the
fallopian tube
(salpingitis) or
an infection of
the uterus,
fallopian tubes
or ovaries
(pelvic
inflammatory
disease)
increases the
risk of ectopic
pregnancy.
Often, these
infections are
caused by
gonorrhea or
chlamydia.

Fertility
issues. Some
research
suggests an
association

to get over. It may

comfort you to know that
if you have an ectopic
pregnancy, you'll likely be
able to have a healthy
pregnancy in the future.

additional blood tests

to make sure that the
entire tubal
pregnancy was
removed.
The blood tests
detect the hCG level,
the hormone that is
produced during
pregnancy.
You can't prevent an
ectopic pregnancy,
but you can decrease
certain risk factors.
For example, limit
your number of
sexual partners and
use a condom when
you have sex to help
prevent sexually
transmitted infections
and reduce the risk of
pelvic inflammatory
disease. Quitting
smoking before you
attempt to get
pregnant may also
reduce your risk.

between
difficulties with
fertility as
well as use of
fertility drugs
and ectopic
pregnancy.

Structural
concerns. An
ectopic
pregnancy is
more likely if
you have an
unusually
shaped
fallopian tube
or the fallopian
tube was
damaged,
possibly during
surgery. Even
surgery to
reconstruct the
fallopian tube
can increase
the risk of
ectopic
pregnancy.

Contraceptiv
e
choice. Pregna
ncy when using
an intrauterine
device (IUD) is
rare. If
pregnancy

occurs,
however, it's
more likely to
be ectopic. The
same goes for
pregnancy
after tubal
ligation a
permanent
method of birth
control
commonly
known as
"having your
tubes tied."
Although
pregnancy
after tubal
ligation is rare,
if it happens,
it's more likely
to be ectopic.

Smoking. Ciga
rette smoking
just before you
get pregnant
can increase
the risk of an
ectopic
pregnancy. And
the more you
smoke, the
greater the
risk.

References:
http://www.rhophylac.com/About-HDN/Rh-sensitization.aspx
http://www.webmd.com/baby/tc/rh-sensitization-during-pregnancy-treatment-overview
http://jn.nutrition.org/content/133/5/1722S.full
http://www.webmd.com/baby/guide/anemia-in-pregnancy
http://www.msdmanuals.com/home/women-s-health-issues/drug-use-during-pregnancy/druguse-during-pregnancy
http://www.mayoclinic.org/diseases-conditions/anemia/basics/definition/con-20026209
http://www.babycentre.co.uk/a1018905/hyperemesis-gravidarum
http://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/basics/prevention/con20024262
http://www.webmd.com/baby/guide/pregnancy-ectopic-pregnancy