Rhogam- I'm so confused! - Page 2

[japonica]

If the test shows you are sensitized, your pregnancy will be monitored more closely, as PP mentioned, unless you opt (and pay for?) the early test to determine the in utero baby's blood type.  I don't know how invasive this test is though (do they insert a needle?  eek!), or if there is any risk for the fetus.  I don't know much about the test, I would like for someone to fill us in here! 

If the initial screen indicates you are sensitized, then the OB will likely do a couple of subsequent screens over a period of weeks to check if it's a false positive from the rhogam shot or to see if the titer starts to rise (which will indicate true sensitization). This happened in my case, My initial one was positive in my first tri prenatal b/w and when I went back for a follow up screen, my titer turned out to be 1:2. 

If true sensitization has occurred, the OB will also do a blood draw on the father to check for his genetic profile for that particular Rh antigen (in this case, D). If he's homozygous for D, then the baby will be positive for D and affected (to whatever varying degrees) by the antibodies. If hubby is heterozygous for D, then that means one positive gene and one negative one, and there's a 50% chance that the baby will be negative for D and unaffected by the maternal antibodies. I know Honeybee mentioned the blood test. The peris I saw (or the OB) never mentioned it (I think it's a relatively new option). The standard has usually been (for babies with heterozygous dads) to do a cordo at about 19w and check the baby's blood type at that time (I don't think cordos can be done earlier...the peris I saw said that they don't transfuse earlier than 19w just because of how small the cord is at that point). If the baby is negative, then it's a normal pregnancy from there out. If the baby is positive, then the peris/MFM team continue monitoring with regular MCA (mid cerebral artery) dopplers, transfuse if necessary with intrauterine transfusions, and try to get the pregnancy past 34w. Of course, no two sensitized pregnancies are alike. Some moms have very little interventions besides monitoring and induction near term (that was my case, I made it to 37w with no transfusions both times) while others have 8-9 IUTs and delivery at 34w with a lot of postnatal care afterwards. I don't advocate for or against rhogam as it's an individual decision...it didn't work in our case (large silent bleed between 32w and delivery that the prenatal dose couldn't counteract), but it's good to know that in this day and age, sensitized moms can still have successful pregnancies.

[RabbitMomma]

Thank you everyone for all the info, it was so helpful! I will be meeting my midwife for the first time next week and plan on asking her opinion on Rhogam, so hopefully I'll get more info then. I sent the Anti-D book to my husband's house and he said the info was very interesting so I'm itching to get my hands on it once I move next week.

I have one more question. I told my mom that I was planning on not having the prenatal shot but taking the test to see if I was sensitised. She told me that the test wasn't very accurate, especially since I was relatively young (22). She also seems to be under the impression that Rhogam should be given if you are already sensitised, so I don't think she quite knows her facts about Rhogam. Either that or she's trying to scare me into getting the shot.  Anyway, is there any truth to the test to see if you're sensitised not being accurate?

[japonica]

I've never heard of the test being completely inaccurate...there are a couple of situations though that can affect its perceived reliability. First is what I described with knowing whether it is true sensitization or the remnants of the rhogam giving a false positive. But that can be determined over time with subsequent testing.

Second, I have heard from other iso moms that their titer levels would sometimes vary if they went to different labs. For example, they'd be 1:4 at one lab and have a repeat done that same week and be 1:8 elsewhere...That's why we'd always recommended to new iso moms that they use the same lab for consistency's sake. I think all titer tests in my city were done by one central organization anyway (in my case, Canadian Blood Services) as it was their requisition.

The erroneous idea of giving rhogam post-sensitization is unfortunately all to common. I encountered it all the time in my OB's office. With my second iso pg, I had one of the nurses phone me to come in for my 28 week shot. The conversation went like this:

"Why?"

"It's because you're Rh negative. You need the shot to stop developing antibodies against the baby."

"I see. The antibodies I already have. The ones you fill out the titer requests for? The ones I see the peri about?"

Pauses. "Um, yeah."

"So you want me to come in to get a shot to prevent something I already have?"

Giggles. "That doesn't make sense, does it? I guess you don't need it after all."

I had to argue with nurses both in the OB's office and in hospital during both pregnancies that I didn't need a winrho shot. You'd think that they'd have a greater understanding of some of this stuff. I think many of them are just going through a routine (Rh negative = rhogam) and don't actually consider it any further than that.

Edited by japonica - 12/31/10 at 8:59pm

[Serenity Now]

I am rh+ but I have been sensitized to a different rh factor. There is no rhogam equivalent for what I have, but if there was, I would have gotten it. We're not sure when it happened, but it was some time during my second pregnancy. We found out after the delivery, so it happened sometime during the pregnancy. There was no "trauma" during my pregnancy at all, so it's a mystery how it happened. My son had very severe jaundice, but got through it OK. His billi numbers were about 23 at 2 days of life.

Now, every pregnancy has to be monitored very closely. The risks of fetal death are very high, if your partner is homozygous that is. Mine is heterozygous, so we have a 50/50 chance of our kids being affected. You don't know until birth, so the pregnancy is considered high risk. I have to go in for ultrasounds to monitor the pressure in the central cerebral artery. The fetus is at risk for severe anemia, swelling, and death. They can do blood transfusions inutero, but those are very risky. After birth, the baby may have to have repeated blood transfusions, and is at risk of kernicterus, a horrible neurological condition. Pregnancy, delivery, and birth become highly medicalized once you are sensitized. I feel like this is not something to mess around with, honestly. Our bodies are assaulted by "toxins" at every turn, and any "toxins" in this shot are probably far less damaging than having your baby's blood attacked and killed by your blood while he or she is still in the womb.

[japonica]

Serenity, I just wanted to post and say that it's unfortunate that you have to go through a sensitized pregnancy. ((HUGS)). That said, with current care provided by peris and MFM teams, success rates are very high. I've been through two iso pregnancies without any issues whatsoever besides jaundiced babies that required double bilis and a week of hospitalization, but no further care required, no postnatal transfusions, nothing. And no after effects from the jaundice either. I've also been on a support group for years and out of the hundreds of iso moms on there, with antibodies from D to Kell (which is trickiest to monitor) to others, we've only had two losses in all that time...And yes, any losses are tragic and heartbreaking, but I also think of the amazing successes of some of our moms...ones with titers in the thousands, who undergo 8 or 9 IUTs, and who still manage to come home with babies at the end of it all. Many of us are cases of rhogam/winrho failure, so I almost feel like science eventually redeemed itself when it failed us to begin with.

 

Rhogam is a personal choice. Even after having had two senstitized pregancies, if I had to do it all again, I personally would not get a prenatal shot, but wait for the postnatal one. That's just my perspective. Even as the wife of a homozygous D hubby.

 

If you would like the link to the BG group, PM me. There's a great community of iso moms, many of whom have had multiple iso pgs, who provide much needed support and advice...they can make going through an iso pg a lot less frightening.

 

P.S. And if your hubby is heterozygous, you can determine the baby's blood type by cordo or PUBS (from about 19w on). Other moms on the forum have had it done. All peris are generally very skilled at the procedure as they only deal with high risk conditions. That way, if baby is negative, the stress is off and also you don't need to be under peri care for the rest of the pregnancy. And, as a bonus, it frees up the peris' time for us unlucky homozygous couples who have to tough it out until the end.

Edited by japonica - 1/1/11 at 4:14pm

[is it puppies?]

I am O- and chose not to get the shot prenatally after all the research I did (apparently there were cases of bloodbourne disease transmitted via the shot in the 80s I believe, and it says it is not tested prenatally, and the stats say that the difference is so minimal I didn't want to risk the prenatal shot for those reasons). I was somewhat undecided as to whether or not I'd get the shot after baby was born if she was positive, but luckily I didn't have to decide as she was A- (DH's father is neg, though DH is pos he must be heterozygous). Barring traumatic incident I will make the same choice next time!