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A 16-year-old girl in her ninth month of pregnancy is admitted to the hospital following an episode of abdominal cramps. She is para 2, gravida 2. The prior delivery resulted in a healthy girl, who was adopted. She has not been able to access prenatal care with this pregnancy and therefore has missed all the routine screening tests, such as an indirect Coombs test. Following admission, tests revealed a high level of Rh antibodies in the maternal blood. The fetus is exhibiting signs of distress and an irregular heartbeat. It was decided that an emergency cesarean section is required. The neonate has marked pallor. He also has an enlarged spleen and elevated serum levels of unconjugated bilirubin. An exchange transfusion is ordered for the neonate. Phototherapy is begun because bilirubin could no longer be excreted through the placenta, leading to a high risk of severe jaundice and potential brain damage.
Discussion Questions
Based on the personal information given, explain how Rh incompatibility and erythroblastosis fetalis has occurred. (See Rh Incompatibility.)
Explain why her first pregnancy was not affected. (See Rh Incompatibility.)
Discuss the prognosis for this child and for future pregnancies. (See Intrauterine Transfusion, Phototherapy, and RhoGAM.)
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