The sensitised booking visit — antenatal counselling and surveillance station

Communication and clinical-reasoning station on the newly-identified alloimmunised pregnancy: candidate explains sensitisation in plain language, sets up serial MCA-PSV surveillance with the 1.5 MoM threshold, describes intrauterine transfusion and outcomes, and addresses the woman's anxiety. Includes assessor key and marking domains.

Prompt

A 31-year-old G3P2 attends her booking visit at 10 weeks. She is blood group O RhD-negative. Her booking antibody screen is positive for anti-D at a titre of 1:64. Her second baby was born at term, was RhD-positive, and required phototherapy for neonatal jaundice but no transfusion. You are the registrar who must counsel her and set up the pregnancy surveillance.

Station brief

Format. Communication and clinical-reasoning station, approximately 12 minutes. You are the antenatal clinic registrar. A midwife and the woman's partner are present. The assessor will feed you the woman's questions and concerns. ^[1]

Candidate instruction. Explain the result to the woman in plain language, lay out the surveillance plan for the pregnancy, describe what happens if the fetus becomes anaemic, and address her anxiety. Verbalise the clinical thresholds and the referral pathway. ^[1]^[2]

References3Show

[1]Moise KJ Jr Management of rhesus alloimmunization in pregnancy Obstet Gynecol, 2008.PMID 18591322
[2]Mari G, Norton ME, Stone J, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia—diagnosis and management Am J Obstet Gynecol, 2015.PMID 25824811
[3]Mari G, Deter RL, Carpenter RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses N Engl J Med, 2000.PMID 10620643

The sensitised booking visit — antenatal counselling and surveillance station

Station brief

References3Show

[1]Moise KJ Jr Management of rhesus alloimmunization in pregnancy Obstet Gynecol, 2008.PMID 18591322
[2]Mari G, Norton ME, Stone J, et al. Society for Maternal-Fetal Medicine (SMFM) Clinical Guideline #8: the fetus at risk for anemia—diagnosis and management Am J Obstet Gynecol, 2015.PMID 25824811
[3]Mari G, Deter RL, Carpenter RL, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. Collaborative Group for Doppler Assessment of the Blood Velocity in Anemic Fetuses N Engl J Med, 2000.PMID 10620643