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Amniocentesis for Rh sensitization during pregnancy

Dr. HelloDox Care #
HelloDox Care
Consult

What is Rh sensitization during pregnancy?
If you are Rh-negative, your red blood cells do not have a marker called Rh factor on them. Rh-positive blood does have this marker. If your blood mixes with Rh-positive blood, your immune system will react to the Rh factor by making antibodies to destroy it. This immune system response is called Rh sensitization.

What causes Rh sensitization during pregnancy?
Rh sensitization can occur during pregnancy if you are Rh-negative and pregnant with a developing baby (fetus) who has Rh-positive blood. In most cases, your blood will not mix with your baby's blood until delivery. It takes a while to make antibodies that can affect the baby, so during your first pregnancy, the baby probably would not be affected.
But if you get pregnant again with an Rh-positive baby, the antibodies already in your blood could attack the baby's red blood cells. This can cause the baby to have anemia, jaundice, or more serious problems. This is called Rh disease. The problems will tend to get worse with each Rh-positive pregnancy you have.
Rh sensitization is one reason it's important to see your doctor in the first trimester of pregnancy. It doesn't cause any warning symptoms, and a blood test is the only way to know you have it or are at risk for it.
If you are at risk, Rh sensitization can almost always be prevented.
If you are already sensitized, treatment can help protect your baby.


Who gets Rh sensitization during pregnancy?
Rh sensitization during pregnancy can only happen if a woman has Rh-negative blood and only if her baby has Rh-positive blood.
If the mother is Rh-negative and the father is Rh-positive, there is a good chance the baby will have Rh-positive blood. Rh sensitization can occur.
If both parents have Rh-negative blood, the baby will have Rh-negative blood. Since the mother's blood and the baby's blood match, sensitization will not occur.
If you have Rh-negative blood, your doctor will probably treat you as though the baby's blood is Rh-positive no matter what the father's blood type is, just to be on the safe side.


How is Rh sensitization diagnosed?
All pregnant women get a blood test at their first prenatal visit during early pregnancy. This test will show if you have Rh-negative blood and if you are Rh-sensitized.

If you have Rh-negative blood but are not sensitized:
The blood test may be repeated between 24 and 28 weeks of pregnancy. If the test still shows that you are not sensitized, you probably will not need another antibody test until delivery. (You might need to have the test again if you have an amniocentesis, if your pregnancy goes beyond 40 weeks, or if you have a problem such as placenta abruptio, which could cause bleeding in the uterus.)
Your baby will have a blood test at birth. If the newborn has Rh-positive blood, you will have an antibody test to see if you were sensitized during late pregnancy or childbirth.

If you are Rh-sensitized, your doctor will watch your pregnancy carefully. You may have:
Regular blood tests, to check the level of antibodies in your blood.
Doppler ultrasound, to check blood flow to the baby's brain. This can show anemia and how severe it is.
Amniocentesis after 15 weeks, to check the baby's blood type and Rh factor and to look for problems.

How is Rh sensitization prevented?
If you have Rh-negative blood but are not Rh-sensitized, your doctor will give you one or more shots of Rh immune globulin (such as RhoGAM). This prevents Rh sensitization in nearly all women who use it.

You may get a shot of Rh immune globulin:
If you have a test such as an amniocentesis.
Around week 28 of your pregnancy.
After delivery if your newborn is Rh-positive.

The shots only work for a short time, so you will need to repeat this treatment each time you get pregnant. (To prevent sensitization in future pregnancies, Rh immune globulin is also given when an Rh-negative woman has a miscarriage, abortion, or ectopic pregnancy.)
The shots won't work if you are already Rh-sensitized.


How is it treated?
If you are Rh-sensitized, you will have regular testing to see how your baby is doing. You may also need to see a doctor who specializes in high-risk pregnancies (a perinatologist).
Treatment of the baby is based on how severe the loss of red blood cells (anemia) is.
If the baby's anemia is mild, you will just have more testing than usual while you are pregnant. The baby may not need any special treatment after birth.
If anemia is getting worse, it may be safest to deliver the baby early. After delivery, some babies need a blood transfusion or treatment for jaundice.
For severe anemia, a baby can have a blood transfusion while still in the uterus. This can help keep the baby healthy until he or she is mature enough to be delivered. You may have an early C-section, and the baby may need to have another blood transfusion right after birth.
In the past, Rh sensitization was often deadly for the baby. But improved testing and treatment mean that now most babies with Rh disease survive and do well after birth.



Cause
Rh sensitization can occur when a person with Rh-negative blood is exposed to Rh-positive blood. Most women who become sensitized do so during childbirth, when their blood mixes with the Rh-positive blood of their fetus. After being exposed, a mother's immune system produces antibodies against Rh-positive red blood cells.
The minimum amount of blood mixing that causes sensitization is not known. Fortunately, Rh sensitization can almost always be prevented with the Rh immune globulin injection.
When an Rh-negative person's immune system is first exposed to Rh-positive blood, it takes several weeks to develop immunoglobulin M, or IgM, antibodies. IgM antibodies are too large to cross the placenta. So the Rh-positive fetus that first triggers maternal sensitization is usually not harmed.
A previously Rh-sensitized immune system rapidly reacts to Rh-positive blood, as during a second pregnancy with an Rh-positive fetus. Usually within hours of Rh-positive blood exposure, smaller immunoglobulin G, or IgG, antibodies are formed. IgG antibodies can cross the placenta and destroy fetal red blood cells. This causes Rh disease, which is dangerous for the fetus.
Some Rh-negative people never become sensitized, even after exposure to large amounts of Rh-positive blood. The reason for this is not known.



Symptoms
If you are already Rh-sensitized or become Rh-sensitized while pregnant, you will not have any unusual symptoms.
Fetal problems from Rh sensitization are detected with Doppler ultrasound testing and sometimes with amniocentesis. It is possible, though, that a fetus with severe Rh disease will move less frequently than it did earlier in the pregnancy.
Other conditions with symptoms similar to Rh sensitization include other blood type incompatibility problems and fetal infections.



What Happens
If you are Rh-negative
Unless you are given Rh immune globulin just before or after a high-risk event, such as miscarriage, amniocentesis, abortion, ectopic pregnancy, or childbirth, you have a chance of becoming sensitized to an Rh-positive fetus's blood.
If you have been Rh-sensitized in the past

If you have been Rh-sensitized in the past, you must be closely watched during any pregnancy with an Rh-positive partner, because your fetus is more likely to have Rh-positive blood. In response to an Rh-positive fetus, your immune system may quickly develop IgG antibodies, which can cross the placenta and destroy fetal red blood cells. Each subsequent pregnancy with an Rh-positive fetus may produce more serious problems for the fetus. The resulting fetal disease (called Rh disease, hemolytic disease of the newborn, or erythroblastosis fetalis) can be mild to severe.

Mild Rh disease involves limited destruction of fetal red blood cells, possibly resulting in mild fetal anemia. The fetus can usually be carried to term and requires no special treatment but may have problems with jaundice after birth. Mild Rh disease is more likely to develop in the first pregnancy after sensitization has occurred.
Moderate Rh disease involves the destruction of larger numbers of fetal red blood cells. The fetus may develop an enlarged liver and may become moderately anemic. The fetus may need to be delivered before term and may require a blood transfusion before (while in the uterus) or after birth. A newborn with moderate Rh disease is watched closely for jaundice.
Severe Rh disease (fetal hydrops) involves widespread destruction of fetal red blood cells. The fetus develops severe anemia, liver and spleen enlargement, increased bilirubin levels, and fluid retention (edema). The fetus may need one or more blood transfusions before birth. A fetus with severe Rh disease who survives the pregnancy may need a blood exchange. This procedure replaces most of the infant's blood with donor blood (usually type O, Rh-negative).
A history of pregnancy with Rh disease is a sign that you will need special treatment when you are pregnant with an Rh-positive fetus.
If you have been Rh-sensitized in the past, an Rh-negative fetus cannot trigger an immune reaction.




Exams and Tests
If you are pregnant, you will have your first prenatal tests during your first trimester. Every woman has her blood tested at the first prenatal visit to see what her blood type is. If your blood is Rh-negative, it will also be tested for antibodies to Rh-positive blood. If you have antibodies, that means that you have been sensitized to Rh-positive blood. The antibodies can now kill Rh-positive red blood cells.
If you are Rh-negative and your partner is Rh-positive, your fetus is likely to be Rh-positive.
If you are pregnant or have miscarried, or if you have had an elective abortion, a partial molar pregnancy, or an ectopic pregnancy, you will need testing to see if you have been sensitized to Rh-positive blood.
If you are Rh-negative
All pregnant women have an indirect Coombs test during early pregnancy.

At the first prenatal visit, your blood is tested to see if you have been previously sensitized to Rh-positive blood. If you are Rh-negative and test results show that you are not sensitized, a repeat test may be done between 24 and 28 weeks.
If test results at 28 weeks show that you have not been sensitized, no additional tests for Rh-related problems are done until delivery (barring complications such as placenta abruptio). You will also have a shot of Rh immune globulin. This lowers your chances of being sensitized during the last weeks of your pregnancy.
If your newborn is found to be Rh-positive, your blood will be screened again at delivery with an indirect Coombs test to see if you have been sensitized during late pregnancy or childbirth. If you have not been sensitized, you will have another shot of Rh immune globulin.

If you are sensitized to the Rh factor

If you are already Rh-sensitized or become sensitized while pregnant, close monitoring is important to determine whether your fetus is being harmed.

If possible, the father will be tested to see if the fetus could be Rh-positive. If the father is Rh-negative, the fetus is Rh-negative and is not in danger. If the father is Rh-positive, other tests may be used to learn the fetus's blood type. In some medical centers, the mother's blood can be tested to learn her fetus's blood type. This is a new test that is not widely available.
An indirect Coombs test is done periodically during your pregnancy to see if your Rh-positive antibody levels are increasing. This is the typical course of treatment for most sensitized women during pregnancy.
Fetal Doppler ultrasound of blood flow in the brain shows fetal anemia and how bad it is. At a medical center with Doppler experts, this test can give you the same anemia information as amniocentesis, without the risks.

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Amniocentesis test

Dr. HelloDox Care #
HelloDox Care
Consult

What Is Amniocentesis test?
Amniocentesis is a prenatal test in which a small amount of amniotic fluid is removed from the sac surrounding the foetus for testing. The sample of amniotic fluid (less than one ounce) is removed through a fine needle inserted into the uterus through the abdomen, under ultrasound guidance. The fluid is then sent to a laboratory for analysis. Different tests can be performed on a sample of amniotic fluid, depending on the genetic risk and indication for the test.

Why Is an Amniocentesis performed?
A complete anatomical ultrasound will be done prior to amniocentesis. but amniocentesis is performed to look for certain types of birth defects, such as Down syndrome, a chromosomal abnormality.Because amniocentesis presents a small risk for both the mother and her baby, the prenatal test is generally offered to women who have a significant risk for genetic diseases,including those who:
1) Have an abnormal ultrasound or abnormal lab screens
2) Have a family history of certain birth defects
3) Have previously had a child or pregnancy with a birth defect

Amniocentesis does not detect all birth defects, but it can be used to detect the following conditions if the parents have a significant genetic risk:
1) Down syndrome
2) Sickle cell disease
3) Cystic fibrosis
4) Muscular dystrophy
5) Tay-Sachs and similar diseases
6) Amniocentesis can detect certain neural tube defects (diseases where the brain and spinal column don't develop properly), such as spina bifida and anencephaly.

Because ultrasound is performed at the time of amniocentesis, it may detect birth defects that are not detected by amniocentesis (such as cleft palate, cleft lip, club foot, or heart defects). There are some birth defects, however, that will not be detected by either amniocentesis or ultrasound. An amniocentesis can also be done during the third trimester of the pregnancy to determine if the baby's lungs are mature enough for delivery, or to evaluate the amniotic fluid for infection.

When is amniocentesis performed?
If your doctor has recommended an amniocentesis, the procedure is usually scheduled between the 15th and 18th week of pregnancy.

How accurate is amniocentesis?
The accuracy of amniocentesis is about 99.4%. Amniocentesis may occasionally be unsuccessful due to technical problems, such as being unable to collect an adequate amount of amniotic fluid or failure of the collected cells to grow when cultured.

Does Amniocentesis have risks?
Yes. There is a small risk that an amniocentesis could cause a miscarriage (less than 1%, or approximately 1 in 200 to 1 in 400). Injury to the baby or mother, infection, and pre term labour are other potential complications that can occur, but are extremely rare.

Can you choose not to have an Amniocentesis?
Yes. You will receive genetic counselling before the procedure. After the risks and benefits of amniocentesis have been thoroughly explained to you, you can choose whether or not you want to have the procedure.

What happens during an Amniocentesis?
A small area of the abdomen is cleansed with an antiseptic to prepare for the amniocentesis. You may receive a local aesthetic (pain-relieving medication) to reduce any discomfort. The doctor first locates the position of the foetus and placenta with an ultrasound. Under ultrasound guidance, the doctor inserts a thin, hollow needle through your abdomen and uterus, and into the amniotic sac, away from the baby. A small amount of fluid (less than an ounce) is removed through the needle and sent for laboratory analysis. You may feel minor menstrual-like cramping or discomfort during the amniocentesis or for a few hours after the procedure.


Can you resume normal activities after an Amniocentesis?
After an amniocentesis, it is best to go home and relax for the remainder of the day. You should not exercise or perform any strenuous activity, lift anything over 20 pounds (including children), and you should avoid sexual relations. You may take two Tylenol (acetaminophen) every 4 hours to relieve discomfort. The day after the procedure, you may resume all of your normal activities unless otherwise directed by your doctor.

When should you call your Doctor after an Amniocentesis?
Call your doctor if you develop a fever or have bleeding, vaginal discharge, or abdominal pain that is more severe than cramps.

When will you receive the results of the Amniocentesis?
The results of the amniocentesis are generally available within 2-3 weeks.

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ऍम्नीऑसेन्टेसिस चाचणी

Dr. HelloDox Care #
HelloDox Care
Consult

ऍम्नीऑसेन्टेसिस चाचणी म्हणजे काय?
ऍम्नीऑसेन्टेसिस ही प्रेणातलं चाचणी आहे ज्यामध्ये गर्भाच्या आसपासच्या अस्थीपासून थोड्या प्रमाणात अम्नीओटिक द्रव काढला जातो. अल्ट्रासाऊंड मार्गदर्शनाखाली, पोटातून गर्भाशयात टाकलेल्या सूक्ष्म सुईद्वारे अॅम्नीओटिक द्रवपदार्थ (एक औंसपेक्षा कमी)काढून टाकला जातो. त्यानंतर द्रवपदार्थ विश्लेषणासाठी प्रयोगशाळेकडे पाठविला जातो. चाचणीसाठी अनुवांशिक जोखीम आणि संकेत यावर अवलंबून, अम्नीओटिक द्रवपदार्थाच्या नमुना वर वेगवेगळे चाचण्या केल्या जाऊ शकतात.

ऍम्नीऑसेन्टेसिस का केले जाते?
ऍम्नीऑसेन्टेसिस करण्यापूर्वी एक पूर्ण रचनात्मक अल्ट्रासाऊंड केले जाईल. परंतु डायन सिंड्रोम,क्रोमोसोमल असामान्यता यासारख्या काही प्रकारच्या जन्म दोषांचा शोध घेण्यासाठी अॅमोनोसेनेसिस केले जाते.
ऍम्नीऑसेन्टेसिस मुळे आई आणि बाळ दोघांनाही थोडा धोका असतो, सामान्यत: ज्या स्त्रियांना आनुवंशिक रोगांचा लक्षणीय धोका आहे अशा स्त्रियांना जन्मपूर्व चाचणी दिली जाते ज्यामध्ये:
असामान्य अल्ट्रासाऊंड किंवा असामान्य लॅब स्क्रीन असल्यास
विशिष्ट जन्म दोषांचा कौटुंबिक इतिहास असल्यास
आधीचे बाळ किंवा गर्भधारणा यामध्ये जन्मविकृती असल्यास
ऍम्नीऑसेन्टेसिस मध्ये सर्व जन्म दोष आढळत नाहीत परंतु पालकांना महत्त्वपूर्ण अनुवांशिक जोखीम असल्यास खालील अटींचा शोध घेण्यासाठी वापरली जाऊ शकते:
डाऊन सिंड्रोम
सिकल सेल रोग
सिस्टिक फाइब्रोसिस
स्नायुंचा विकृती
टाय -साचस आणि समान रोग
ऍम्नीऑसेन्टेसिस काही न्यूरल ट्यूब दोष (रोग आणि मेरुदंड स्तंभ योग्यरित्या विकसित होत नाहीत अशा रोगांचा शोध घेऊ शकतात) जसे की स्पाना बायिफाडा आणि ऍन्सेन्फेली.
अल्ट्रासाऊंड अम्नीओसेनेसिसच्या वेळी केले जाते, कारण ऍम्नीऑसेन्टेसिस (जसे की क्लेफ्ट टॅलेट,क्लिफ्ट होंठ,क्लब फुट किंवा हृदयरोग) यांनी जन्मलेल्या दोषांचा शोध लावला जाऊ शकतो. काही जन्माच्या दोष आहेत, परंतु ती ऍम्नीऑसेन्टेसिस किंवा अल्ट्रासाऊंडद्वारे आढळली जाणार नाही.
गर्भधारणेच्या तिसर्या तिमाहीदरम्यान बाळाचे फुफ्फुस प्रसूती करण्याकरिता परिपक्व्व आहेत की नाही हे तपासण्यासाठी किंवा अॅन्नीओटिक द्रवपदार्थाचे संसर्ग करण्यासाठी हे ऍम्नीऑसेन्टेसिस देखील केले जाऊ शकते.

ऍम्नीऑसेन्टेसिस कधी केले जाते?
जर आपल्या डॉक्टरांनी ऍम्नीऑसेन्टेसिसची शिफारस केली असेल तर ही प्रक्रिया सामान्यत: गर्भधारणाच्या 15 व्या आणि 18 व्या आठवड्यादरम्यान निर्धारित केली जाते.

ऍम्नीऑसेन्टेसिस किती अचूक आहे?
ऍम्नीऑसेन्टेसिस ची शुद्धता सुमारे 99.4% आहे.
तांत्रिक समस्यांमुळे ऍम्नीऑसेन्टेसिस कधीकधी अयशस्वी होऊ शकते, जसे की कल्चर करतांना वाढीव प्रमाणात अम्नीओटिक द्रवपदार्थ संग्रहित करणे किंवा संग्रहित पेशींचे अयशस्वी होणे शक्य नाही.

अनीनीओसेनेसिसवर धोके आहेत का?
हो.अमीनोनेसिसमुळे गर्भपात होऊ शकतो (1% पेक्षा कमी किंवा 400 पैकी सुमारे 1 ते 1 ते 400). बाळ किंवा माता, संसर्ग, आणि पूर्वीच्या श्रमांचे दुखणे हे इतर संभाव्य गुंतागुंत आहेत, परंतु ते अत्यंत दुर्मिळ आहेत.

ऍम्नीऑसेन्टेसिस करण्याचा किंवा न करण्याचा पर्याय निवडू शकतो का?
हो. प्रक्रियेपूर्वी आपल्याला अनुवांशिक सल्लामसलत मिळेल. ऍम्नीऑसेन्टेसिस च्या जोखमी आणि फायद्यांविषयी आपल्याला पूर्णपणे समजावून सांगितल्यानंतर, आपण प्रक्रिया कशी करायची हे आपण निवडू शकता.

ऍम्नीऑसेन्टेसिस दरम्यान काय घडते?
एन्टीसेप्टिकसह अमीनीटिसिस तयार करण्यासाठी पोटाचा एक छोटा भाग शुद्ध केला जातो. आपल्याला कोणतीही गैरसोय कमी करण्यासाठी स्थानिक ऍनेस्थेटीक (वेदना मुक्त करणारे औषध) प्राप्त होऊ शकते. डॉक्टर प्रथम गर्भाच्या स्थितीची आणि अल्ट्रासाऊंडसह प्लेसेंटाची जागा शोधते. अल्ट्रासाऊंड मार्गदर्शनानुसार, डॉक्टर आपल्या ओटीपोटाच्या आणि गर्भाशयाद्वारे आणि बाळापासून दूर असलेल्या अम्नीओटिक पिशव्यामधून पातळ,सुई घालते. सुईद्वारे थोड्या प्रमाणात द्रव (औंसपेक्षा कमी) काढला जातो आणि प्रयोगशाळेच्या विश्लेषणासाठी पाठविला जातो.
ऍम्नीऑसेन्टेसिस दरम्यान किंवा प्रक्रियानंतर काही तासांनंतर आपल्याला अल्पवयीन मासिक पाळीसारखे त्रास किंवा अस्वस्थता जाणवते.

ऍम्नीऑसेन्टेसिस नंतर मी सामान्य क्रियाकलाप पुन्हा सुरू करू शकता?
ऍम्नीऑसेन्टेसिस नंतर, घरी जाणे आणि उर्वरित दिवसासाठी आराम करणे चांगले आहे. आपण व्यायाम करू नये किंवा कोणतीही उग्र क्रिया करू नये आणि आपण लैंगिक संबंध टाळले पाहिजे.
अस्वस्थता दूर करण्यासाठी आपण प्रत्येक 4 तास दोन टायलेनॉल (एसिटामिनोफेन) घेऊ शकता. प्रक्रियेच्या एक दिवसानंतर, आपण आपल्या सर्व सामान्य क्रिया पुन्हा सुरू करू शकता जोपर्यंत आपल्या डॉक्टरांद्वारे निर्देशित केले जात नाही.

डॉक्टरांना ऍम्नीऑसेन्टेसिस नंतर केव्हा बोलवावे?
जर आपल्यास ताप आला असेल किंवा रक्तस्त्राव, योनीचा स्त्राव किंवा ओटीपोटात वेदना होत असेल तर ती जास्त गंभीर असेल तर आपल्या डॉक्टरांना कॉल करा.

ऍम्नीऑसेन्टेसिस चे परिणाम कधी प्राप्त होतील?
ऍम्नीऑसेन्टेसिस चे परिणाम साधारणतः 2-3 आठवड्यांमध्ये उपलब्ध होतात. आपल्याला 3 आठवड्यांच्या आत परिणाम न मिळाल्यास, आपल्या आरोग्य सेवा प्रदात्यास कॉल करा.

Dr. Sunil Ugile
Dr. Sunil Ugile
BAMS, Proctologist, 18 yrs, Pune
Dr. Manish Jawale
Dr. Manish Jawale
MD - Homeopathy, Homeopath, 17 yrs, Pune
Dr. Vikas Kumar
Dr. Vikas Kumar
Specialist, Gastroenterologist, Pune
Dr. Shyamsundar Jagtap
Dr. Shyamsundar Jagtap
BAMS, Ayurveda Panchakarma, 9 yrs, Pune
Dr. Chandrakant Raut
Dr. Chandrakant Raut
BAMS, Family Physician General Surgeon, 4 yrs, Pune
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