A G4, P1, L0 female comes for antenatal checkup at 12 weeks of gestation. She has had two prior 1st trimester surgical MTPs, and delivered a 7 month boy in her last pregnancy who died 14 days after birth due to jaundice. She reveals that her blood group is B negative and that she was monitored with repeated blood tests in her last pregnancy. There is no history of anti-D administration. True regarding her management is:
Ans. A. Monitor the pregnancy with MCA PSV valuesThere is already a history of prior affection of pregnancy due to Rh alloimmunization which is clear from her history. In this case, further management in subsequent pregnancy is for early detection of fetal anemia by monitoring the pregnancy with MCA (middle cerebral Doppler) studies directly beginning from 18 weeks onwards or at least 10 weeks prior to when the last affected pregnancy was affected.Since the woman is already iso immunized, there is no role for repeated titres or prophylactic anti-D injection anymore.
Monitor the pregnancy with MCA PSV values
Weekly ICT for anti-D titres to be done
Give anti-D injection at 28 weeks if ICT negative
Give anti-D injection irrespective of the ICT result
Miscellaneous (Obs)