ISOINMUNIZACION MATERNA PDF

PHD caused by Rh incompatibility is usually severe, but its incidence has decreased in the past years tremendously thanks to implementation of antenatal Rh D immune globulin prophylaxis in women who are Rh - non-alloinmunized. In case that a PHD generates, the degree of anemia can be classified as mild, moderate or severe depending on the fetal hemoglobin level in relation to the gestational age and the physiological effect it has on the fetus. The treatment of PHD consists primarily on intrauterine fetal transfusion IUT and ending pregnancy if the fetus is viable. There are multiple methods to assess the severity of the PHD like the measurement of anti Rh agglutinins, analysis of the change in optical density of amniotic fluid at nm on the spectral absorption curve delta OD to determine amniotic fluid bilirubin, ultrasonography to assess signs of hydrops fetalis edema, ascites, effusions , fetal blood sampling and doppler assessment of the fetal middle cerebral artery MCA peak velocity.

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PHD caused by Rh incompatibility is usually severe, but its incidence has decreased in the past years tremendously thanks to implementation of antenatal Rh D immune globulin prophylaxis in women who are Rh - non-alloinmunized. In case that a PHD generates, the degree of anemia can be classified as mild, moderate or severe depending on the fetal hemoglobin level in relation to the gestational age and the physiological effect it has on the fetus.

The treatment of PHD consists primarily on intrauterine fetal transfusion IUT and ending pregnancy if the fetus is viable. There are multiple methods to assess the severity of the PHD like the measurement of anti Rh agglutinins, analysis of the change in optical density of amniotic fluid at nm on the spectral absorption curve delta OD to determine amniotic fluid bilirubin, ultrasonography to assess signs of hydrops fetalis edema, ascites, effusions , fetal blood sampling and doppler assessment of the fetal middle cerebral artery MCA peak velocity.

In general the severity of the PHD in a pregnancy tends to be similar or more severe than previous pregnancies. We present a patient that was Rh alloinmunized with history of two fetal deaths week 29th and 30th of gestation associated with Rh alloinmunization and a premature birth of 28 weeks that was sent to CERPO for follow up and management.

It was decided to follow the current pregnancy with serial doppler assessment of the fetal middle cerebral artery MCA peak velocity. Rev Chil Ultrasonog. Volumen 9: Hemograma materno y primera TIV. Control pre y post transfusional segunda y tercera TIV.

Controles Vmax ACM. Tabla IV. Volumen transfundido y hematocrito pre y post TIV. Posteriormente desarrolla una displasia broncopulmonar leve. Dado de alta a los dos meses de vida con control fosfatasas alcalinas de U. Inmunizaciones producidas durante el embarazo. Osorio A. Tabla V. Niveles de hemoglobina fetal esperados para determinada edad gestacional. Paciente de alto riesgo a. Paciente de bajo riesgo a. Sin antecedentes de enfermedad fetal o neonatal.

Tabla VII. Antecedentes de embarazos previos de alto riesgo para EHP. Antecedentes de alto riesgo a. Hidrops fetal en embarazos anteriores. Tabla VIII Valores de Vmax de arteria cerebral media para determinada edad gestacional. Vmax de arteria cerebral media para determinada edad gestacional. Cuadro 1 La ACM debe ser visualizada en toda su longitud.

Los resultados son graficados en curvas normalizadas para la EG respectiva. Las curvas fueron originalmente ideadas por Liley, el cual divide las curvas en tres zonas que determinan el riesgo de anemia fetal severa Antes de la semana 27 se pueden usar curvas modificadas creadas por Queenan Menos de 35 semanas de embarazo. En el caso presentado, las transfusiones realizadas, en dos oportunidades se hicieron con valores de VmaxACM con MoM sobre 1,29 y no sobre 1,5 debido a los antecedentes de alto riesgo que presentaba la madre en embarazos previos.

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Todos los derechos reservados. El objetivo del tratamiento preventivo es evitar que una mujer con factor Rh negativo produzca anticuerpos contra el Rh desde un principio. De las 2 pacientes La inmunoglobulina contra el Rh impide isoibmunizacion el cuerpo produzca anticuerpos, por lo que evita que ocurra anemia fetal grave en un embarazo futuro. La muestra generalmente se obtiene durante la primera visita prenatal. Mexico Language of fulltext: Gas necesario para poder vivir. En el periodo de estudio ingresaron 4 mujeres Rh negativo 4.

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