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Foetal hydrops (Aetiology (Vascular Cardiac abnormalities Foetal…

- - - - Rh blood groups
        Rh blood groups are three linked gene pairs, one allele of each is dominant (Cc, Dd, Ee); but only 5 antigens as d is absence of D
        Mendelian inheritance, with D most significant cause
        Also c, E and atypical Kell
      - Rhesus disease
        Foetal cells cross into maternal circulation
        If foetus carries an antigen the mother doesn't have, a maternal Ab response is mounted, producing sensitised IgM Abs
        The IgM Abs cannot cross the placenta, first pregnancy not at risk
        Re-exposure in subsequent pregnancy causes memory cells to produce IgG Abs, which can cross the placenta
        The Abs enter the foetal circulation and destroy foetal RBCs, causing foetal haemolytic anaemia; if severe, can lead to hydrops
        Milder cases see neonatal anaemia or jaundice
      - Sensitising events
        TOP, evacuation after miscarriage
        Ectopic pregnancy
        PV bleeding during pregnancy
        Blunt abdominal trauma
        Invasive uteriine procedure (amnio, CVS)
        Intrauterine death
        Delivery