Book of Medical Disorders in Pregnancy - Tintash

place if the infant develops jaundice. All
newborn infants who are visibly jaundiced,
near (between 35 – 37 weeks)
and full (>38 weeks) term should have a
bilirubin level determined. Infants, although
not visibly jaundiced but with
two or more risk factors should have at
least one bilirubin level preformed prior
to discharge. Serum bilirubin may be
done on either capillary or venous blood
sample. Infants with severe or prolonged
jaundice should have further investigations
including an analysis of the
conjugated component of the bilirubin.
A Transcutaneous bilirubin
measurement may be used if available as
a screening device.
Inhibition of conjugation:
Certain physiologically produced
steroids i.e. pregnanediol, pro Gest
erone, and others inhibit conjugation of
bilirubin. Successive infants of certain
apparently normal mothers have been
found to develop high levels of
unconjugated bilirubin which lead to
kernicterus. The mechanism of jaundice
production is probably an exaggeration
of physiological inhibition of conjugation.
(Lucey-Driscoll Syndrome). In survivors
the resulting jaundice disap-pears
within a month as normal conjuga-tion
mechani-sms appear. Novobiocin has
also been shown to inhibit conjuga-tion
in vitro, and there is an increased
incidence of unconjugated hyperbilirubinemia
in infants receiving this drug,
which is now seldom used and is not
available in Pakistan.
Treatment of hyperbilirubinemia -
Early milk feedings and glycerin suppository
have been shown to decrease the
serum bilirubin level, presumably by
enhancing early evacuation of gut con-
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tents, including bilirubin. In infants with
hemolytic processes, regular check up of
hematocrit and reticulocyte count is
necessary. Treatment depends on many
factors, including the cause of the
hyperbilirubinemia and the level of
bilirubin. The goal is to keep the level of
bilirubin from increasing to dangerous
levels. Treatment may include:
Prevention of Rh sensitization -
Usually large fetomaternal bleeds which
are enough to produce Rh sensitization
occur during delivery, after abortion and
separation of placenta. With Kleihauer
acid elution and staining technique an
actual count of the number of fetal cells
in the maternal circulation, can be made.
It has been observed that dose of more
than 0.25 ml. of fetal Rh-positive cells is
needed to produce immunization.
When ABE incompatibility between mother
and child, is present the fre-quency
of Rh sensitization is diminished, because
the maternal anti A and Anti-B
destroys the fetal Group A or B. Rh
positive cells before a maternal response
can occur. Avoidance of unnec-essary
intrauterine manipulation can also help
to lower the incidence of sensitiza-tion.
Anti D gamma globulin:
Rh-immune globulin is produced from
plasma of highly sensitized men and
women. This plasma is pooled and clear
fraction is separated which contains
highly concentrated IgG, Anti Rh-D and
is free of the hepatitis virus. The
antibodies are concentrated and distributed
in 1 ml dose containing approximately
300 mcg of Anti D, and is given
intramuscularly, within 72 hours after
delivery. This 72 hour period is specified
because the clinical trials which tested