RhoGAM?

[THBVsMommy]

Someone please point me in the right direction. I have a negative blood type and received 2 doses of this injection in my first pregnancy. Once at 28 weeks and the other after delivery.

I've began to research on it simply because it's a vaccine and I refuse them for my son, so of course I'm wary about having them done to myself. I wasn't educated on vaccines when I was pregnant with DS, but began after he was born and now we do not vax at all.

I'm finding some conflicting research on this particular vaccine that's really just leaving me between a rock and a hard place. Is it really nothing but beneficial, as I know there is a risk of Hemolytic disease if my baby has is Rh positive and our antibodies collide? Or am I putting him at just as much a risk of other serious complications in consenting to this vaccine?

I'm really just overwhelmed, so any information, links, advice you can offer is greatly appreciated. I've read of some mercury free brands of the shot and would be willing to pay the extra for those, but I still want more information before coming to any decisions. Thank you!

[Medusa]

Well the first question is what is you husbands blood type. I know that's über- basic, but still strangly over looked by most OBs and CNMs.

If his blood type is also negative than it becomes a nonissue as all babies born to you as couple will also be Rh-.

[stik]

Rhogam isn't a vaccine. It's a dose of antibodies. If you have artificial antibodies in your system, they will deal with any Rhesus factor that your system may encounter during a pregnancy without triggering an immune reaction that could kill any future children you may wish to have.

If your partner is RH- as well, there is no need for this, as your children will all be RH-, and won't produce any Rhesus factor for you to react against.

Hemolytic disease won't kill THIS baby (at least, not typically) - it will kill future ones.

You can get Rhogam without mercury.

[japonica]

Hemolytic disease won't kill THIS baby (at least, not typically) - it will kill future ones.

It will probably NOT kill future ones. I've had 2 successful sensitized pregnancies when my winrho shots failed. Yes, I was higher risk and sent to a peri for monitoring, but will careful care, most sensitized pregnancies ultimately result in healthy, living babies.

There are quite a few threads on rhogam in the Birth and Beyond forum.

Personally, I don't think a lot of it based on my experience. I was given three prenatal shots in my first pg. They failed anyway plus my first baby was stillborn for unknown reasons at term but the pathology and autopsy showed that some kind of immune reaction took place that cut off all blood flow in the placenta and from the IUGR rates it started after my last prenatal shot, which is an odd coincidence. Later I looked into how rhogam and winrho is made, from the pooled plasma of thousands of donors and the package insert event says that it may contain CJD or other unknown infectious agents. It's also a class C drug and has not been evaluated for safety on pregnant women.

Sensitization is not a great outcome but it's also NOT the end of the world either.

[stik]

Japonica, I'm very sorry for your loss.

As you note, Rhogam doesn't always protect against sensitization. It's fantastic and amazing that you've had two successful pregnancies following sensitization. Your experience is highly atypical. RH sensitization causes serious problems including fetal organ damage and death in many cases. These complications have been rare since the use of Rhogam became routine.

In contrast, there are absolutely no recorded cases of any blood borne pathogens being transmitted through the Rhogam shot.

[japonica]

Atypical? I belong to an online BG of sensitized women, everything from anti-D to the others that are not preventable through injection and with the hundreds of members we have, there have only been 2 losses, both times the babies were lost before they could receive transfusions. All of the other mothers have had satisfactory outcomes and healthy babies. The level of perinatal care these days for Rh issues is very high (having just been through it myself personally twice) so it has advanced tremendously even from 5 years ago. And there are many, many anti-D moms on there, so I suspect the failure rate is higher than what many believe it to be.

Whether or not the medical establishment reports any transmission of an infectious nature is not something I rely on. The manufacturer themselves report that they do not screen for everything. It is a blood product and other blood products in the past have led to infection. If there is an infectious agent present that 1) the manufacturer does not or cannot screen for at present and 2) standard lab tests do not or cannot detect currently, then what would there be to report? So, no reports doesn't mean a lot to me, especially when most doctors and scientists refuse to believe in or report adverse vaccine reactions and other permanent damage related to vaccines.

[13Sandals]

Stik wrote:

In contrast, there are absolutely no recorded cases of any blood borne pathogens being transmitted through the Rhogam shot.

No. This is completely untrue. A large number of women in Ireland received compensation when it was discovered that a batch of Rhogam (Anti-D) was contaminated with Hep C. At the time, they did not screen for this particular virus. Of course, they screen for it now, and any other KNOWN vriuses. Rhogam is a whole blood product, you can be certain there are undetectable levels of many viruses present as well as, as of yet, unidentified viruses. Of course there is a risk.

You should find out your hubby's blood type. If he's negative, there is no possible way to have a positive blood type baby - no shot. If he is positive, the system of pregnancy is designed to keep the mother and baby's blood separate. Therefore, in a perfect world, no sensitization would occur. If, (heaven forbid) you had a potentially sensitizing event (like accident, fall on the stomach, miscarriage, traumatic birth like a cesarean - anything that might cause the baby and mother's blood to intermix) - you could decide to get the shot in that case. This is what used to be recommended when the shot first came on the market. You have, theoretically, at least 48 hours after a sensitizing event (my midwife told me I had up to 7 days and would still be fine) to get the Rhogam - (which, as one poster said, is not a vaccine, but antibody shot).

Of course, you could have a small bleed, or sensitizing event without knowing it and risk an antibody response, but as was said, the danger to the current pregnancy would be next to nothing - not to say there would NEVER be a risk, but the odds are overwhelmingly in your favor. The antibody response takes a while to build.

I am a negative blood type and took Rhogam with my first (my hubby is positive), but refused the rhogam for my next two. I decided to have the baby's blood typed after the birth. I decided that if the baby was a positive blood type, I would review the birth and decide if I wanted the shot. However, my husband turned out to be heterozygous for the rhesus factor and my next two children were negative blood types!

[amnesiac]

Since this is not vaccine-related I'm going to move it over to B&B where I think you will likely get more pertinent information.

[stik]

13Sandals, I hadn't heard of the Irish cases. Do you have a source for those?

Japonica, I'm thrilled to hear that the new treatments for sensitization are so successful. That said, given a choice between:
a) a shot in the hip that almost always works, or
b) an intensely managed and monitored pregnancy with umbilical transfusions a high chance of medically necessary c-section, and a still higher than normal chance of serious complications and fetal death,

I'll take the shot in the hip.

I don't think option b is the end of the world if it all works out. But I do think I'd rather prevent it if I could.

[tessie]

Originally Posted by stik

Japonica, I'm thrilled to hear that the new treatments for sensitization are so successful. That said, given a choice between:
a) a shot in the hip that almost always works, or
b) an intensely managed and monitored pregnancy with umbilical transfusions a high chance of medically necessary c-section, and a still higher than normal chance of serious complications and fetal death,

I'll take the shot in the hip.

I don't think option b is the end of the world if it all works out. But I do think I'd rather prevent it if I could.

:

The two losses mentioned by Japonica are just two too many for my liking.

[japonica]

Stik, to each their own. I had all the shots, performed by doctors, in the doses recommended, and they still failed, and my child died for unknown reasons with a decline right after the last shot. Knowing what I do now, I would never get another prenatal shot but everyone's risk-benefit analysis on these things is different.

Yes and it is great that the perinatal care for sensitized mothers is so good so that when it does fail (and for some women it always will) and when the medical community that tells us it is foolproof is proven wrong that we still have the option of having healthy babies. Oh and I never had a single IUT, not one in 2 pregnancies, nor did I have any c-sections and both of my babies were born at term. If I were a few years younger, I'd definitely have one more child.

I am not recommending anyone either choose or forgo a rhogam shot. What I do take exception to is overgeneralizing how "bad" things are for sensitized pregnancies. Like I said, I have been through 2 now with NO complications. I am on a BG with hundreds of women who have had healthy babies (yes, some after IUTs and early inductions) but they were not at any higher mortality risk than a lot of other high risk mothers out there.

Any loss is tragic. But to automatically equate sensitization with a death sentence for a child is not accurate nor a true portrayal of the experiences of most of the women out there.

And Tessie, one of the losses was a mother with anti-M and anti-C contracted through previous blood transfusions. Anyone who has ever had a blood transfusion also has to watch for this. No rhogam would have prevented her child's death.

[bluedaisy]

I spent MONTHS researching rhogam....eventually I decided to decline the 28 week shot, get my baby tested after birth, and then get the rhogam after delivery IF my baby was positive.

She was positive, so I got the shot after she was born.

These were my main reasons:

- There were NO safety studies done on rhogam's effect on the fetus. the only studies i could find were testing if giving the shot at 28 weeks was effective, NOT if it was safe

- rhogam is a blood product. it is impossible to screen for all viruses, known and unknown. the rhogam website even acknowledges that risk

- before the 1990s, it was standard procedure in the US to wait until the baby was born, test the baby, and then give Rhogam if positive. this got sensitization rates down to 1-2%. then they found out giving it at 28 weeks decreased the risk to less than 1%. Many countries still only give Rhogam after the baby is born. to me, a 1-2% risk was still a really low chance of being sensitized.

- every source acknowledged that mom's blood and baby's blood mixing in the womb was very rare. most blood mixing and therefore sensitization occurs at birth. I would have considered getting rhogam before birth if I had had a fall, accident, or bleeding or spotting, all of which can increase the risk of blood mixing before birth.

- I talked with homebirth and birth center midwives who do not routinely offer the 28 week shot but only the postpartum shot.

My hospital based midwives were NOT happy with this decision, and for four appointments straight they tried to scare me into getting it. after every appointment, i would do further research and gain more confidence in my decision.

finally i printed out all the research i had done and printed a letter with my main reasons for declining the 28 week shot and told them if they had more recent research that contradicts what i've found then i would be willing to reconsider.

all of my links are on my old comp - PM me if you want more info.

good luck!!

[Delicateflower]

Originally Posted by tessie

:

The two losses mentioned by Japonica are just two too many for my liking.

:

Not to mention having so many ultrasounds and such a medically managed pregnancy.

I found this on the complication rate on transfusion in utero. Scary!

What is intrauterine blood transfusion?: Intrauterine blood transfusion is a highly specialized procedure where a fetus, while still inside the uterus, is given a blood transfusion to treat severe anemia (low blood level). The goal of this procedure is to prevent stillbirth from anemia, and to prolong the pregnancy to a point where prematurity is no longer a significant risk.

How is intrauterine blood transfusion performed? Intrauterine blood transfusion is a highly complex procedure, generally performed only by a perinatologist. Ultrasound is used to visualize the umbilical cord and the point where it attaches to the placenta. A needle is then placed into the vein of the umbilical cord at this site, and, based on fetal size and blood count, a calculated volume of blood is transfused into the vein in order to restore the baby’s blood level to normal.

Who is a candidate for intrauterine blood transfusion?: The most common reason an intrauterine blood transfusion is performed is when a fetus is severely anemic due to an incompatibility with maternal blood. Because of the risks of the procedure, it is only performed at early gestational ages, when delivery is not an option because of the risks of prematurity. It can also be performed for fetal anemia caused by certain viral infections. Usually, there will have been many other tests performed to evaluate these problems before the final decision for intrauterine blood transfusion is made.

What are the risks of the procedure?: Depending on the reason for the procedure and the condition of the fetus, there may be as much as a 5% to 7% chance of some type of complication during the procedure that would make immediate delivery via cesarean section necessary, or lead to loss of the fetus by still birth. That is why this procedure is only performed if there is a high chance of losing the baby if the procedure is not done. Although these risks are fairly small, the procedure is performed in a labor and delivery unit so that immediate intervention can be instituted if a complication occurs.

http://www.communitymed.org/RMPA_Int...ne_Transfusion

I'm sorry, I'm very glad they can help these babies now, and it's not a death sentence, but for me and my baby losing the normal healthy pregnancy and birth and post-natal experience over the miniscule risk of a blood product is not worth it.

[japonica]

I imagine it does sound scary when someone who has not gone through a sensitized pregnancy reads about it. Yet, for many of the iso moms, they do not see it in the same way. I know women on their 5th (yes, 5th) sensitized pregnancy, complete with the IUTs. You'd think this would be reason enough for them not to continue having children, but for a lot of them they see this as part of the risk. The majority of moms in the group have gone through multiple IUTs with no losses. The only losses were the ones who did not get the IUTs in time. And none of the women I met online were ones who became sensitized through declining rhogam/winrho. We were all sensitized anyway through product failure or physician negligence. There is often a lot of shock and anger when mothers find out they are positive. We had been told that the product almost always works and would keep our future pregnancies safe. Yet from the sizeable number of moms who keep joining us, either the product has a larger failure rate than advertised or physicians are not administering it properly and in the time window mandated.

There is also a sizeable number who have other antibodies besides D (the one in the rhogam shot) who were sensitized through blood transfusions during previous m/cs, deliveries etc. These are also problematic antibodies (some equally or more dangerous than D, like Kell for instance) and I urge anyone who has had a blood transfusion to make sure that they did not develop any of these antibodies.

As for ultrasounds, my children had about 10 each. I'd take those over losing them to HDN or getting multiple amnios every 2 weeks. And to date, neither has shown any ill effects. My daughter is 4 and a half and reading at a grade one level already. My son has reached his milestones on time. Both are extremely healthy.

Like I said, I am not advocating that people refuse rhogam but that they really consider all the issues and make the decision that works best for them. For some, that will be declining it completely (I know some moms on their last pg who have done this). Or only doing the shot postpartum IF the child is Rh positive. And for others, prenatal shots is something they feel most comfortable with. Everyone's analysis of the situation is different.

[Delicateflower]

Originally Posted by japonica

Yet from the sizeable number of moms who keep joining us, either the product has a larger failure rate than advertised or physicians are not administering it properly and in the time window mandated.

But with the known failure rate of 1%, and 4 million births a year, 15% of whom are rh-, that's 6,000 new sensitisations a year. Do you have more than that join your list a year?

Originally Posted by japonica

I know women on their 5th (yes, 5th) sensitized pregnancy, complete with the IUTs. You'd think this would be reason enough for them not to continue having children, but for a lot of them they see this as part of the risk.

As for ultrasounds, my children had about 10 each. I'd take those over losing them to HDN or getting multiple amnios every 2 weeks.

This is a false analogy. The choice is not between a dead baby and lots of ultrasounds and IUT and prematurity, but between a rhogam shot and lots of ultrasounds and IUT and prematurity and a dead baby.

[japonica]

Originally Posted by Delicateflower

But with the known failure rate of 1%, and 4 million births a year, 15% of whom are rh-, that's 6,000 new sensitisations a year. Do you have more than that join your list a year?



This is a false analogy. The choice is not between a dead baby and lots of ultrasounds and IUT and prematurity, but between a rhogam shot and lots of ultrasounds and IUT and prematurity and a dead baby.

Yes, well, that's if the rhogam shot works to prevent sensitization, which as you pointed out is not always the case. And it is also if refusal equals sensitization, which has also not been the experience of every mother. I do know of a few who have refused for various reasons and have not become sensitized. So, there's a few variables to add to your analysis.

[Delicateflower]

Originally Posted by japonica

Yes, well, that's if the rhogam shot works to prevent sensitization, which as you pointed out is not always the case. And it is also if refusal equals sensitization, which has also not been the experience of every mother. I do know of a few who have refused for various reasons and have not become sensitized. So, there's a few variables to add to your analysis.

I would take 0.4% chance of being sensitised with rhogam over the 7% (1 in 15) chance of being sensitised without it.

[bluedaisy]

I would take 0.4% chance of being sensitised with rhogam over the 7% (1 in 15) chance of being sensitised without it.

there is a much smaller chance of getting sensitized if she only refuses the 28 week shot, and her risk is still less than 2%.

there hae been NO safety studies done on fetuses for giving rhogam at 28 weeks - that doesnt concern you?

drugs are being recalled all the time because there were side effects that they just didnt know about.

a developing fetus is so sensitive, and they really have no idea if rhogam affects the fetus or not.

there are NO drugs or vaccines that are 100% safe, every drug has its risks. it drives me crazy when people talk about the situation like sensitization is the only risk.

Honestly, the risk of sensitization is small, but it's a real risk. the risk of harming the fetus with rhogam is small, but it is also a real risk.

[stik]

Bluedaisy, what negative impacts on fetuses do you think the 28 week shot may be causing? What data is your concern based on?

I don't think it's appropriate to compare the real, known risks of sensitization with the imagined, hypothetical risks of the 28 week shot.

(Though personally, I wouldn't opt for the 28 week shot unless something happened that made me think my personal risk of sensitization was high - like a car accident.)

[bluedaisy]

Stik, you even said that you wouldnt get the 28 week shot - if you don't think there's a risk to it, why wouldnt you get it?

There are very real risks to the 28 week shot (I am only talking about the risks to the fetus in the 28 week shot, NOT the postpartum shot, which I did receive)

- The risk of a virus or other blood borne pathogen - from the official Rhogam website:

RhoGAM® and MICRhoGAM® Ultra-Filtered PLUS Rho(D) Immune Globulin (Human) are made from human plasma. Since all plasma-derived products are made from human blood, they may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD) agent.

We simply don't know the effects on the fetus of exposure to viruses or other blood borne pathogens.

- also from the rhogam insert, there is a risk that IgE antibodies are present in Rhogam.

IgE antibodies are the antibodies that a mother's body creates in subsequent pregnancies that attack the baby if the mother is sensitized.

If IgE antibodies in the mother's blood attack the positive baby, wouldn't IgE antibodies in Rhogam also attack the baby?

If I'm understanding correctly, that is why japonica beleives her baby was stillborn (i am so sorry for your loss).

When I was researching, I encountered several women whose babies were stillborn or born severely anemic, and they believed it was due to the Rhogam shot.

Someone mentioned that the two losses that the sensitized women had were two too many - i agree, but what about babies who were lost because of Rhogam? Those numbers are also small, but EQUALLY TRAGIC.

This is not a situation of a "harmless" shot in the hip vs a serious medical condition.

- Finally, rhogam used to contain mercury. In looking at the population of women with autistic children, rh negative women were disproportionately represented. pregnant women are told to limit fish intake because of mercury, and yet for years they injected mercury directly into the bloodstream of pregnant women.

I realize mercury is no longer in rhogam - however, there are other preservatives that we simply do not know how they will affect the fetus because there havent been safety studies done.

Most pregnant women are so careful with every little thing they consume or drugs they take while pregnant because they realize there is a risk that a foreign substance can harm their baby.


Finally, other thing I considered while I was pregnant was that taking Rhogam at 28 weeks put my baby at risk (regardless of how small that risk was, it was still a risk)

Not taking rhogam would put my future babies at risk (again, a small risk but still a risk - and a risk that I could minimize by taking the rhogam shot AFTER my baby was born)

In my mind, I had to protect the baby that I had at that moment. I hope to have 3-4 children, but there is no guarantee that I will ever have any more children.

So, it made sense to me to only get the shot after birth - that way, my baby was at NO RISK from rhogam, and I was still minimizing the risk of sensitization for future babies by getting the rhogam shot after birth.

Hope that helps, good luck in your decision, I spent months going back and forth as I was reading the research. But after weeks of fighting with my midwives over it and reading the research again and again, I am confident in my decision and will not be getting hte 28 week shot with any future pregnancies unless I have an accident or bleeding or something that makes me a high risk for sensitization.