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antigens
molecules that are recognized by the immune system
antibodies
proteins used by the immune system to identify and neutralize foreign objects.
There are two components to a blood type, which are...
The ABO type: A, B, AB, or O
And the Rh factor: - or +
is the _____ to the _________ and was discovered during research using _____ monkeys
suffix
ABO blood type
Rhesus monkeys
Rh factor is either _____ (meaning the person has the antigen) or _______ (meaning the person does not have the antigen)

Examples
positive, negative

 A-, AB+, O-, etc.
If an Rh- person is exposed to blood that contains the Rh antigen (so Rh+ blood); the Rh- person will _________ against the ________. Over time, as antibody levels rise, these antibodies will ________red blood cells that contain the __________.
produce antibodies, against

destroy, RH antigen (meaning it is Rh+ blood)
If mother is Rh- and baby is Rh+, what will likely happen during a...
1)first pregnancy
2)subsequent pregnancy
1) nothing, as antibodies take time to develop
2)maternal antibodies could cross the placenta and attack fetal BCs and destroy them via hemolysis
An ___________is a blood test that can indicate if a mother has already been "sensitized" to the Rh antigen (meaning she has already built antibodies against it).

If the test is +, what may be at risk?
indirect Coomb's test

well being of the fetus
Can Rh incompatibility affect infant bilirubin?
Yes, the infant's bilirubin level may rise very rapidly causing non-physiologic or "pathologic" jaundice as well as more serious complications.
How does Rh- mom get spurned to produce Rh antibodies by Rh+ fetus?
Cells from the Rh+ fetus enter woman's bloodstream
To address Rh+ presence in an Rh- mother, __________ can be administered to the mother (via ____________) to prevent her body from producing antibodies against Rh+ blood.
Rhogam
IM
If the mother's indirect Coomb's test is______, Rhogam is given prophylactically at __weeks gestation, following _______, or ______________.
-
28 weeks gestation
amniocentesis
spontaneous/induced abortion.
Rhogam is also given within _______ hrs of birth only only if baby is ____.
It is also given within 72 hours of birth only if the baby is Rh+
Administration of Rhogam will help prevent...
Administration of Rhogam will help prevent an Rh reaction in subsequent pregnancies.
If mother is Rh- and baby is also Rh-, is Rhogam needed after birth?
No.
A type blood has
_ antigens
_ antibodies
and will react with the _ antigens of _ blood   
A type blood has A antigens and B antibodies so it will react with the B antigens of B type blood
B type blood has
_ antigens
_ antibodies
and will react with the _ antigens of _ blood
B type blood has B antigens and A antibodies so it will react with the A antigens of A type blood.
AB type blood has
_ antigens
_ antibodies
and will react with _ antigens of _ blood

will it cause a reaction?
AB type blood has A and B antigens and no antibodies so it is the universal recipient because it has no antibodies to cause a reaction
O type blood has
_ antigens
_ antibodies
and will react with the _ antigens of _ blood
O type blood has no antigens (*remember O means "0"  for zero antigens) and both A and B antibodies. Therefore, O is the universal donor; however, if anO type person is given AB, or AB type blood, an antibody reaction will occur.
maternal-fetal ABO incompatibility can cause...
maternal-fetal ABO incompatibility can cause non-physiologic "pathologic" jaundice in the newborn.
If mother has O type blood
(_ and _ antibodies)    
and the fetus has A, B or AB type blood

the mothers _ and _ antibodies can cross the ______ and cause a reaction with the infant's ________ 

When this occurs, it can cause ________ of the ______ blood when means increased production of _______ in the  infant 
 A and B antibodies)
 and B antibodies, placenta, antigens.
 hemolysis , infant's blood, bilirubin (hyperbilirubinemia)
ABO and Rh incompat
-fetal blood may test direct Coombs...

Indirect Coombs used to test whether... 

Direct Coombs tests ____ blood from _____ at the time of _____    

-positive

-Rh- mother has become Rh sensitized  

-infant,   umbilical cord, delivery
If infant tests DIRECT Coombs positive, it means that...
it means that some type of maternal-fetal antigen/antibody reaction has occured and that the infant is at increased risk for developing non-physiologic jaundice.
Can ABO incompatibility:
-affect first pregnancy?
-be prevented via treatment w/ medication or other means?

Is it typically less severe than Rh incompatibility?
-yes
-no

-yes, it is typically less severe than Rh incompatibility  
intrauterine fetal demise
Intrauterine fetal demise describes the in-utero death of a fetus at any gestation.
spontaneous abortion (and AKA)
spontaneous abortion, commonly referred to as a miscarriage, is a spontaneous pregnancy loss that occurs before 20 weeks gestation
stillbirth
stillbirth is used to describe the death of a fetus at any time after 20 weeks gestation.
What % of fetal losses have no specific cause of death?

When do most of these unexplained deaths occur? 
25-38%

After 35 wks gest
Potential known causes for fetal demise

  • Multiple gestations—Monoamniotic cord entanglement, twin-to-twin transfusion



  • Genetics—Chromosomal defects, genetic abnormalities



  • Congenital Malformations--Congenital anomalies, amniotic band syndrome



  • Placental problems—Abruption, calcifications



  • Cord accidents—Nuchal cords, true knots, compression



  • Post-term pregnancy



  • Medical Diseases in mother—Diabetes, renal disease, hypertension, lupus



  • Maternal Infections—HIV, parvovirus, cytomegalovirus, rubella

Kubler-Ross' five stages of grief experienced by patients

  • Denial and Isolation



  • Anger



  • Bargaining



  • Depression



  • Acceptance

Vogel's stages of grief in the loss of a child

  • Avoiding the New Reality



  • Admitting the New Reality



  • Adapting to the New Reality

Details of:



  • Avoiding the New Reality



  • Admitting the New Reality



  • Adapting to the New Reality

Avoiding the new reality encompasses feelings of shock and denial. 

Admitting the new reality includes feelings of anger, guilt, emptiness, loneliness,  and depression. 

Adapting to the new reality involves the acceptance that the family will never be the same but the pain is becoming less acute. The family is beginning to get on with life. They know they won't ever forget their baby, but they also don't want to.
IUFD
intrauterine fetal demise
how is IUFD similar to live birth
-IV for...
-increasing...
-monitoring...
-is pain med given?
-will pushing be needed?
-perineal repair needed?
-hold/see baby?
-afterbirth pain?
-lactation?
-fluids/meds
-intensity of contractions
-contractions
-yes
-pushing needed for mins or hours
-possible perineal repair
-yes, can see/hold baby
-yes
-yes, lactation        
IUFD different from live birth
-fetal monitoring?
-pain med doses?
-after birth noise
-prep patient for appearance of baby
-autopsy ordered?
-lactation... suppress?      
-no
-can be higher
-no noise
-note "normal changes" after death
-autopsy may be ordered
-suppress lactation even for mid trimester deliveries
Things to say/do after IUFD

  • "I'm so sorry your baby has died"



  • "Tell me how you are"



  • "It's alright to cry. Your baby has died"



  • Ask the baby's name



  • Handle the baby with care



  • Give a hug



  • Hold a hand

Things to not do or say IUFD

  • "It's God's will"



  • "You can have other children"



  • "At least you have other children"



  • "You have an angel in heaven"



  • "It's better that you lost the baby now before you got to know it"



  • Refer to the baby as a "fetus" or "specimen"



should holding/seeing IUFD baby be forced?
no, even though it's generally understood to be important
Helping parents make memories IUFD

  • Taking photos



  • Obtaining footprints



  • Making handprints



  • Saving a lock of hair (ask permission)



  • Making plaster casts of the baby's hands and/or feet



  • Saving the hospital bracelets



  • Making a bead bracelet with the baby's name



  • Dressing the baby in clothes (from home, purchased, or provided by hospital)



  • Wrapping the baby in a blanket



  • Saving ANYTHING that touched the baby—a cap, diaper, shirt, tape measure, etc.



  • Making a "Memory Box"

labor
process of moving fetus placenta and membranes out of uterus through birth canal
in 1st time pregs, the uterus sinks downward and forward how long before term?

What is this called?
2 weeks before term

lightening or dropping
does lightening usually resulf in increased bladder presure?

what does this mean returns?

when may lightening occur in a multiparous pregnancy?
yes

increased urinary freq

after uterine contract estab and true labor in process
Yes/No: happens in days preceding pregnancy
-backache
-braxton hicks (strong but irredular uterine contract)
-vag mucus more profuse
-bloody show
-cervix ripens (becomes soft) and partially effaced, maybe dilates
-spontaneous memb rupture
-Yes to all
Yes/No: common in days preceding labor
-loss of .5-1.5 kg in weight, caused by water loss from elect shifts resulting from est and prog level shifts
-surge of energy  
Yes to all. Just know them.
onset of labor - what contributes to the occurence of stong, regular , rhythmic contractions?
-increased conc of estro and prostaglandins, decreased progesterone lvls
-horomes produced by fet hypothal, put and adrenal cortex
-uterine distention, intrauterine pressure, placental aging - ASSOCIATED WITH WHAT? 
-increased myometrial pressure
What is a prot found in plasma and cervicovaginal secretions of preg women before onset of labor?

is it used to asses for likelihood of preterm labor  in at risk women?
fetal fibronectin

yes
"normal" labor
when women is at or near term,
no complications exist,
single fetus presents by vertex
18 hours or less completion
FIRST STAGE OF LABOR
-from onset of reg contractions to _____ dilation of cervix

-is it longer or shorter than second and third combined?

-what can affect duration of first-stage labor?
-full

-generally much longer

-parity (full dilation may occur in less than an hour in some multpar pregs, in first-time pregs it can take 18hrs or longer
3 phases of 1st stage of labor
-latent
-active
-transition

describe
-latent: more progress in effacement of cervix and little increase in descent
-active and transition: more rapid dilation of cervix and increased rate of descent of presenting part
what can cause active phase of labor to be longer?
maternal pre-preg overweight and obesity
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