RH Case 13

DAY 1
-Non Stress Test (NST): 2 FHR accelerations, 15bpms above baseline, lasting 15 s
econds, in a 20 min period --> reactive.
The Fetal NST is done after 28 weeks gestation. Normal results: Variabil
ity >5, no decels, accels present.
-Maternal kick counts, 10 over a span of 1-2 hours, if too few, do a NST. If NST
is non-reactive, do Contraction test (Oxytocin challenge test): oxytocin infusi
on,
3 contractions in 10 minute period, late decels are non-reassuring.
-Biophysical Profile: Fetal breating, Fetal tone, Body movement, Amniotic fluid
volume, NST (2 points for each mini test, with a high score of 10)
-Fetal death >20 weeks is a stillbirth, if <20 weeks it is a misscarriage. Cause
s: placental problems, infection (1/10), birth defects (chromosomal), IUGR
-HSV-2 genital herpes, primary has more severe symptoms (increased risk of trans
mission). Transmission during labor, in birth canal, during outbreak.
-Acyclovir helps to decrease breakout of herpes. If there is a breakout at the t
ime of labor, then perfom C-section.
-GBS (group B strep.) is strep. agalactiae which is gram +, beta hemolytic, lanc
efield group B antigen, catalase negative, and is present in GI, perineum, and v
agina.
Its most common in the neonatal period.
-15-40% of pregnant women are colonized with GBS, transmission is during labor/d
elivery, and treatment of fetus is penicillin G IV.
-Immune hydrops fetalis (10-20% of hydrops): Rh incompatibility-->hemolytic dise
ase of newborn
-Non-Immune hydrops fetalis (80-90% of hydrops): increase in third space buildup
due to cardiac/lung failure, severe anemia (thalessemia or infection),
or genetic (Turners). Severe edema.
-Hydrops fetalis has a 50-100% mortality rate.
DAY 2
-Erythroblast: nucleated RBC (parvovirus will infect). Reticulocyte: immature RB
C without nucleus.
-Infections that cause non-immune hydrops fetalis: parvovirus B19, cytomegalovir
us, HSV, toxoplasmosis, treponema pallidum.
-Parvovirus: single stranded DNA virus, prefers nucleated erythroid/progenitor c
ells. Binds to blood group P antigen (globoside).
It decreases the following: erythrocytes, lymphocytes, granulocytes, pla
telets.
It causes edema, severe anemia, congestive heart failure --> Hydrops Fet
alis!
-Early signs of hydrops: an ultrasound that detects fluid in cavities, thickened
placenta. Treatment: IgG for B19 parvovirus can help.