Case

A 26- year old woman, who is pregnant for the 2nd time, comes to the clinic because of burning on urination and increased urinary frequency for the past 8 days. Physical exam reveals costovertebral angle tenderness. She was diagnosed with UTI, for which she got an appropriate treatment. 

Mother took RhoGAM during 3rd trimester and  in early postpartum period.

At 39 week of gestation a baby was delivered vaginally. On physical exam of the infant, the physician notes the presence of condition, which was complicated with bile deposits in basal ganglia. 

Which of the following is the most likely cause bile acids deposit in basal ganglia ?

a) due to SMT-TMP drug treatment 

b) due to type O mother and type B fetus 

c) due to Rh⊖mother, Rh⊕ fetus 

d) due to Rh⊕ mother, Rh⊖fetus 

Correct is C

This 26- year old woman have Rh⊖ and her baby  Rh⊕ , which  caused the incompatibility of the blood group and lead to Rh hemolytic disease of the newborn. Hemolytic disease  usually occurs during 2nd and  subsequent pregnancies 

Since it is her 2nd pregnancy her immune system has already developed anti-D IgG. Because of this, getting RhoGAM (anti-D IgG) will not help during this pregnancy

This condition can lead to hydrops fetalis, jaundice and kernicterus(bile acid deposits it basal ganglia ) .

Other answers:

a) SMX-TMP is a 1st line treatment for urinary tract infection (UTI).  Although  its use is contraindicated in pregnant women because it’s teratogenic effect(one of the adverse effects is Kernicterus). So the answer is incorrect because she got an appropriate treatment.

b) Type O mother and type B fetus cause ABO hemolytic disease of the newborn, which can as well cause jaundice, but not as severe as in Rh-hemolytic disease and does not lead to Kernicterus (bile acid deposits in basal ganglia), therefore this answer is not likely to be correct.

d) Rh⊕ mother and Rh⊖ fetus cannot lead to Rh hemolytic disease of the newborn. Thereby will not cause Kernicterus (bile acid deposits in basal ganglia).