Dullness to percussion and pleural rub suggest disease extension beyond the bronchi such as seen with pneumonia. Paroxysms of cough followed by inspiratory whoop and vomiting suggests pertussis. Prevention
Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing may also be protective. Furthermore, an oral whole cell nontypeable Haemophilus influenzae vaccine given in the fall has demonstrated short term effectiveness in reducing the frequency and severity of the disease during the winter. Treatment
Most cases are self-limited and resolve themselves in a few weeks. Pain medications may help with symptoms. Other recommendations may include rest and keeping well hydrated. Antibiotics
Evidence does not support the general use of antibiotics in acute bronchitis. A systematic review found antibiotics reduced cough by an average of 12 hours (out of a total average of about 14–28 days). Antibiotics caused more side effects such as nausea and diarrhoea, and also may promote antibiotic-resistant bacteria. It is possible they are useful in susceptible groups such as the frail and elderly but there was not enough research information to determine this.Calling acute bronchitis with benign-sounding labels such as chest cold or viral infections may reduce antibiotic usage by improving patients satisfaction when antibiotics are not prescribed. Smoking cessation
To help the bronchial tree heal faster and not make bronchitis worse, smokers should quit smoking completely. Alternative therapeutic approaches
Salbutamol is not effective in children with an acute cough who do not have restricted airways.
Fetal-maternal haemorrhage is the loss of fetal blood cells into the maternal circulation. It takes place in normal pregnancies as well as when there are obstetric or trauma related complications to pregnancy. Normally the maternal circulation and the fetal circulation are kept from direct contact with each other, with gas and nutrient exchange taking place across a membrane in the placenta made of two layers, the syncytiotrophoblast and the cytotrophoblast. Fetal-maternal haemorrhage occurs when this membrane ceases to function as a barrier and fetal cells may come in contact with and enter the maternal vessels in the decidua/endometrium. Description
Normal pregnancy
It is estimated that less than 1ml of fetal blood is lost to the maternal circulation during normal labour in around 96% of normal deliveries. The loss of this small amount of blood may however be a sensitising event and stimulate antibody production to the foetal red blood cells, an example of which is Rhesus disease of the newborn. Abnormal pregnancy
Causes of increased foetal-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found. Up to 30ml of foetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or foetus. Loss in excess of this may result in significant morbidity and mortality to the fetus. Fetal-maternal haemorrhage is one cause of intrauterine death (IUD). Diagnosis
The Kleihauer–Betke test is a blood test used to measure the amount of foetal hemoglobin transferred from a foetus to its mothers bloodstream.