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Saturday, 14 December 2013

Rh Negative Disease in Pregnancy

Rh Negative Disease is a hemolytic disease of a newborn (HDN), as a result of a conception of Rh- mother and Rh+ positive father, leading to a Rh+ pregnancy, causing destruction of blood cells in a fetus. The disease ranges from mild to severe. In most case, it could lead to fatal in the past and complications of the baby but could not affect the mother's health.

Causes
Rh Negative is caused by no protein found on the surface of red blood cells. While most of population have a genetic RH+, a woman with RH- is at risk of fetus complications if she becomes pregnant.

Diagnosis and test
1. Blood test
a. Flow cytometry
Type of optical analysis and separation of cells and metaphase chromosomes by light scattering and fluorescence to confirm the passing and volume of fetal blood into the maternal circulation.
Flow cytometry is used very comomlt in the diagnosis of blood disorder, including blood cancer.
In a study of "Detection of Trace Amounts of Fetal RhD-Positive Red Cells with Flow Cytometry after Multiple Rh-Negative Intrauterine Transfusions and RhD-Gene Determination with PCRR." by Lynena, T.J. Leglera, J.H. Maasa, A. Surenb, R. Osmersb, B. Behringc, W. Schroeterc, M. Koehlera, researchers found that Polymerase chain reaction (PCR) analyses showed the presence of RhD-gene sequences in both cases. Therefore, FC and PCR seem to be suitable methods for the diagnosis and the monitoring in cases of imminent hemolytic disease due to anti-D alloimmunization. With further transfusions, both children developed well after delivery.

b. Coombs test
The test is to determine the IgG antibodies that have passed through the placenta that can lead to hemolytic disease of the fetus.

c. Full blood count
It is a test of information of in a patient's blood, including red blond cells, white blood cells, and platelets.

d. Etc.

2. Bilirubin
The test is to check for the levels of bilirubin excreted in bile and urine, the elevation of levels of bilirubin is an indication of certain diseases.

e. Etc.

3. Ultrasound
Pelvic ultrasound is an image test by using high frequency sound waves to generate the the image which will be sent to your doctor to examine for any abnormality in the pelvic. It is often used in managing the progress of the fetus in the RH- pregnant mother.

Prevention, treatment and management
A. Prevention
Most Rh negative disease can be prevented by treating the mother during pregnancy or within 72 hours after childbirth. Please make sure you and your partner understand that you must talk to your doctor even before having a baby. If you are women with RH- and married to a men with RH+. If you are unsure, please have a blood test.

B. Treatment
The diseases had been deadly in the past, but today, it is treatable.
Rho(D) Immune Globulin
Rho(D) Immune Globulin is a type of medicine of anti-RhD used in a RH negative diseases of a newborn by binding to fetal Rh D positive red blood cells to prevent the complication caused by Rh- mother. The medicine is given by intramuscular injection. Some researchers suggested that Rho (D) Immune Globulin should to be given all RH- women at the 28 weeks of pregnancy.
According to the guidance of "The clinical effectiveness and cost effectiveness of routine anti-D prophylaxis for RhD-negative women in pregnancy." posted at the national institute for health and clinical excellent suggested that Routine antenatal anti-D prophylaxis is recommended as a treatment option for all pregnant women who are RhD negative and who are not known to be 'sensitised'.
2. Risks and side effects
a. Allergic reactions to skin such as skin rash, itching, etc.
b. Breathing difficulty
c. Swelling of the face, lips, or tongue
d. Fever
e. Chest pain
f. Yellow color of skin
g. Etc.
If the symptoms persist, please talk t0 your doctor.

C. Management
C.1. During pregnancy
1. Ultrasound
Pelvic ultrasound is an image test by using high frequency sound waves to generate the the image which will be sent to your doctor to examine for any abnormality in the pelvic. It is often used in managing the progress of the fetus after treatment of Rho(D) Immune Globulin in the RH- pregnant mother.

2. Intrauterine blood transfusion
Intrauterine blood transfusion may be necessary for the fetus by blood transfusion into fetal umbilical vein or into fetal abdomen.

3. Analysis of maternal anti-RhD antibodies
It is necessary to measure the levels anti-RhD antibodies, increasing levels of anti-RhD antibodies must be treated quickly.

4. Etc.

C.2. Soon after child birth
1. Phototherapy for the newborn
Most children born with Rh Negative Disease have a levels of bilirubin of more than 85 umol/l (5 mg/dL), a indication of jaundice.
2. Exchange transfusion
If necessary, by removing the newborn's red blood cells or platelets and replace them with transfused blood products.
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