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Complete blood count
9%
4/44
Urinalysis
11%
5/44
Fibrinogen level
5%
2/44
Urine protein to creatinine ratio
Rhogam (anti-D immune globulin) administration
70%
31/44
Select Answer to see Preferred Response
This patient’s fetus is in breech presentation, requiring ECV. Because ECV can cause small amounts of fetal blood to enter maternal circulation, administration of Rhogam (anti-D immune globulin) is important for preventing Rh alloimmunization. Mothers who do not have the Rh antigen may develop alloimmunization in a subsequent pregnancy if exposed to the antigen during a prior pregnancy. They will then produce anti-Rh antibodies that destroy the fetal red blood cells and cause life-threatening anemia in the fetus. This is preventable by administering Rhogam (anti-D immunoglobulin) when there is a possibility of exposure to fetal blood – such as in ECV, ectopic pregnancy, delivery, abdominal trauma, etc. Routine administration of Rhogam is also recommended for all Rh negative women at 28-32 weeks gestation. Incorrect Answers: Answer 1: Complete blood count (CBC) could provide helpful information on this patient’s anemia, but this lab test is not immediately indicated in the setting of her ECV. There is little risk of major bleeding with ECV, making a CBC unnecessary. Answer 2: Urinalysis is useful for identifying urinary tract infections, which are more common in pregnancy. Although this patient does have a history of pyelonephritis, she does not have urinary symptoms and is appropriately on nitrofurantoin suppression. Urinalysis is therefore not indicated. Answer 3: Fibrinogen is low in cases of placental abruption. Although ECV is associated with a slightly increased risk of placental abruption, it is not necessary to test preemptively for fibrinogen. Answer 4: Urine protein to creatinine ratio is an indicator of proteinuria (which can be used instead of 24-hour urine collection). This test would be useful if preeclampsia were suspected. This patient’s mild pitting edema is physiologic in pregnancy and should not raise suspicion of preeclampsia. Bullet Summary: Rhogam should be given to Rh negative women exposed to external cephalic version, delivery, ectopic pregnancy, molar pregnancy, chorionic villus sampling/amniocentesis, or trauma, all of which which may expose the mother to small amounts of fetal blood.
4.4
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