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Samenvatting module 1: Rh-immunisatie
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Korte, duidelijke samenvatting van powerpoint van Rh-immunisatie
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Module 1Rh-immunisatie
Gevolgen:
- Productie van IgG antistoffen
- Transplacentaire passage
- Facocytose en vellulaire toxiciteit
- Destructie van foetale erythrocyten
- Hyperdynamische compensatie
- Decompensatie en hydrops
Oorzaken:
- Foeto-maternele transfusie
o Tijdens bevalling, vlokkentest, vruchtwaterpunctie, buiktrauma, placentaloslating, uitwendige kering,
curettage na miskraam, EUG
- Latrogene transfusie = veroorzaakt door medische handeling/arts
- Orgaantransplantatie
Diagnose:
- Cordocentese = aanprikken of doorsteken van navelstreng bij ongeboren baby : navelstrengpunctie
- Amniocentese (vruchtwaterpunctie) om graad van hemolyse te bepalen, bilirubine, via spectrophotometry
- Echografie: ascites (vocht in buik), pleurale effusie (vochtophoping tussen borstvliezen), pericardiale effusie (vocht
in pericardiale holte), oedeem, polyhydramnion, cardiale decompensatie (hartfalen), placentomegalie (abnormaal
sterke groei placenta)
Behandeling:
- Intra uteriene transfusie <35w
o Lange termijnuitkomsten: lotusbevalling (navelstreng niet afknippen tot navelstreng vanzelf afvalt)
Preventie:
- Routine postnatale prophylaxis voor RhD negatieve vrouwen met RhD positieve baby
o Anti-D binnen 48u
- Bepaling foetale RBC in maternaal bloed
- Richtlijnen:
o Early TOP with curettage
o Late TOP
o Abortion > 10 weeks
o Extra-uterine pregnancy
o Mola Hydatiformis
o Antepartum hemorrhage >10 weeks
o Abdominal trauma
o External version (attempt)
o IUD = intra uteriene device (spiraal)
o Invasive fetal procedure (bloedonderzoek)
o Amniocentesis
o CVS = chronische vermoeidheids syndroom
o Cordocentesis (afnemen van bloedmonsters uit navelstreng)
o Fetoscopy
ABO-immunisatie:
- Moeder bloedgroep O, dus anti-A en anti-B antilichamen zijn normaal aanwezig
- Kind bloedgroep A of B
- Ook in 1ste zwschap
- Milde hemolytische anemie
- Belangrijke hyperbilirubinemia
- Niet progressief bij volgende zwschap
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