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in depth questions regarding Rhogam given for Trauma before 28 weeks

post #1 of 49
Thread Starter 

Rhogam is a blood product which is pooled. It is actually a blood product from RH - mothers along with sensitizing their blood. Hence, Rhogam.  I understand the "This is how we treat mothers who are Rh-." but I am looking for more in depth info in relation to my questions specifically. 

 

I have researched the Rhogam / Anti-D shot. I am currently pregnant and am O- Neg blood type. I had the RHD genotype test done (via my blood) to test the fetal blood type. The fetus blood type tested as positive. I understand the Rhogam is "routinely" given to all RH - mothers at 28 weeks. If you have a healthy pregnancy, but all of a sudden an accident happens or trauma that caused bleeding before 28 weeks which would require you to go into the hospital immediately and get and the Rhogram shot, I'm wondering what does the Rhogram shot actually do to help the current baby.

This is my first pregnancy. I am still a little uncertain if bleeding occurs and you go into the hospital to get the Anti D shot, what and how does it help the current child (who is positive) in relation to the blood mixing? I have read in literature it only works by protecting your next pregnancy and has nothing to do with the current pregnancy. So I'm a little confused if trauma happens and I were to get the shot, what does it actually do for the current child, and will and how does help the current child the mothers blood (RH- and babies blood RH+) were to mix? 

 

While I have done research and understand the general how Rhogam works. My question is more specific with this scenario. It is sort of confusing to me how it actually works in a trauma situation where the mothers blood (negative) has mixed with the babies blood (positive). Within 72 hours the shot is given. If trauma has happened within those 72 hours and the blood has already mixed, how will the Rhogam shot help prevent what has already started? I do understand it works similar to a "flu shot" injecting just enough so your body fights it off. But if the blood has already mixed within 72 hours or even after 5 hours if trauma has happened where the blood is confirmed to have mixed and my blood is already "attacking" the fetus, I'm not understanding how the Rhogam shot would help the current baby exactly?

post #2 of 49
You could definitely develop antibodies & wind up with an isoimmunized current pregnancy in that scenario. There is *always* blood mixing (that is why they are even able to do the fetal test from maternal blood), just usually not sufficient enough to cause isoimmunization.

In a trauma scenario, the fetus could begin to be affected right away. Best case scenario this just requires monitoring, worst it ends in StillBirth.

The Rhogam works by providing antibodies so your body does not manufacture them. It always works the same way. In some Trauma scenarios, isoimmunization happens anyway, typically that is because of delays (no need to wait 72 hours!) or insufficient quantity of Rhogam (there are formulas but medical professionals are mostly woefully undereducated about proper admin, beyond the basics).
post #3 of 49
ETA: The only reason it mostly does not affect the current pregnancy is that in a normal, trauma free pregnancy, *sufficient* blood mixing does not occur until delivery, if then.
post #4 of 49
When blood mixing happens, it takes a few days for antibodies to develop. The hope is that prompt administration of rhogam can prevent antibodies from developing and attacking the fetus.
post #5 of 49
Thread Starter 

Thank you for your responses.  I have had the test done for anitbodies, and I have none. I have not been sensitized.  I have a normal healthy pregnancy. I am RH - and Baby is tested RH+

 

Quote:
The shot does work after pregnancy when it can not possibly harm the baby.
It is said by some that it offers no additional benefit during pregnancy.
The safety concern duringpregnancy is real.  It doesn't make sense to inject antibodies into the
mother's blood stream that are designed for the sole purpose to eliminate
cells of the baby? There are numerous case reports of babies born anoxic
and asphyxiated because the RHoGam antibodies crossed the placenta during
the gestation period. This is not the only safety concern with the
injection, just the most obvious.

 

The problem is that injecting Rhogam during gestation you are getting
protection for your second pregnancy at the expense of your first. If you
put Rhogam antibodies into your body during your first pregnancy you are
putting antibodies against your baby into your blood stream where, if blood
mixing does occur, those antibodies will attack your baby. This is exactly
what you are trying to avoid for the second pregnancy. So, in reality you
are protecting your second pregnancy from the antibodies by injecting them
into yourself during the first pregnancy. I can't state it any better than
this: if you inject Rhogam during your first pregnancy you will prevent a
potentially harmful situation for your next pregnancy by causing that exact
same harmful situation in your first pregnancy.
 

REF: http://www.nccn.net/~wwithin/rhogam.htm


Edited by Catmom2 - 11/24/13 at 12:44pm
post #6 of 49
Thread Starter 
Quote:
Originally Posted by dinahx View Post



In a trauma scenario, the fetus could begin to be affected right away. Best case scenario this just requires monitoring, worst it ends in StillBirth.
 

 

So getting the rhogam shot due to trauma wouldn't help being the fetus is affected right away, (blood already mixed).  If you got the  test to detect transplacental hemorrhage right there and then in the emergency room, and it detected transplaental hemmorrage, what would be the point of rhogam helping if the blood has already mixed?

post #7 of 49
The shot acts to PREVENT isoimmunization, which cannot be reversed once initiated by the body. If the antibodies take care of the exposure, there is no need for your body to isoimmunize.

The greatest Rhogam benefit is postnatal, that is because the greatest blood mixing is during delivery. However even with postnatal Rhogam, 1% of women will still be isoimmunized in normal pregnancies. The 28 week shot reduces that to 0.1%.

Rhogam that is Thimerisol free in no way adversely affects the fetus, the affect is on the *mother*. It is not harming the existing baby for the benefit of the next baby @ all.

Isoimmunized pregnancies involve more ultrasound, more driving to MFM doctors, more anxiety. IMO not worth it . . .
post #8 of 49
What you don't seem to understand is the levels of antibodies required to adversely affect a fetus. Even in an isoimmunized pregnancy, the body has to produce a certain level of antibodies to cause harm. Those levels are simply not present in Rhogam. They have to build up over time, which they will, if the body is allowed to isoimmunize.

I personally want as many low risk pregnancies as I can have. A transplacental hemorrhage would threaten a current Rh+ fetus *unless* sufficient Rhogam was given in a timely manner. The danger to the baby is not from the blood mixing itself (which again, always occurs to some degree) but from the mother's body learning to manufacture copius quantities of those antibodies, unchecked.
Edited by dinahx - 11/24/13 at 1:21pm
post #9 of 49
And I am not a huge Rhogam lover, I also had my fetus tested this pregnancy in hopes of avoiding it (which I was able to do as my current fetus is Rh-) but beliefs about it that are not grounded in fact simply help no one.
post #10 of 49
I'd challenge you to find even one case of a baby born Hypoxic because of Rhogam 12 weeks prior to delivery. Feel free to search VAERS, the cases are not there. It is just not possible.
post #11 of 49
Thread Starter 
Quote:
Originally Posted by Catmom2 View Post
 

Thank you for your responses.  I have had the test done for anitbodies, and I have none. I have not been sensitized.  I have a normal healthy pregnancy. I am RH - and Baby is tested RH+

 

 
The shot does work after pregnancy when it can not possibly harm the baby.
It is said by some that it offers no additional benefit during pregnancy.
The safety concern duringpregnancy is real.  It doesn't make sense to inject antibodies into the
mother's blood stream that are designed for the sole purpose to eliminate
cells of the baby? There are numerous case reports of babies born anoxic
and asphyxiated because the RHoGam antibodies crossed the placenta during
the gestation period. This is not the only safety concern with the
injection, just the most obvious.

 

The problem is that injecting Rhogam during gestation you are getting
protection for your second pregnancy at the expense of your first. If you
put Rhogam antibodies into your body during your first pregnancy you are
putting antibodies against your baby into your blood stream where, if blood
mixing does occur, those antibodies will attack your baby. This is exactly
what you are trying to avoid for the second pregnancy. So, in reality you
are protecting your second pregnancy from the antibodies by injecting them
into yourself during the first pregnancy. I can't state it any better than
this: if you inject Rhogam during your first pregnancy you will prevent a
potentially harmful situation for your next pregnancy by causing that exact
same harmful situation in your first pregnancy.
 

Forgot to add the REF:  for the above cut/paste  : http://www.nccn.net/~wwithin/rhogam.htm  

 

While I cannot say I agree 100% with statements, I can only go by fact. Fact is Rhogam has helped babies, I will never argue that.  But is it necessary for every RH- woman that has a healthy pregnancy?   I am referring to prenatal rhogam of course at 28 weeks.  My doctor actually advised me I do not need it at 28 weeks, because I have a healthy pregnancy.  It is only recommended if trauma where to occur of course.  Which is why I am asking for any literature/links in relation to my specific questions etc.

 

I do appreciate your feedback from others who are willing to present valid fact behind their statements and glad you are trying to help in any case.  Not looking for drama.  Peace.

post #12 of 49
Quote:
Originally Posted by Catmom2 View Post

Thank you for your responses.  I have had the test done for anitbodies, and I have none. I have not been sensitized.  I have a normal healthy pregnancy. I am RH - and Baby is tested RH+

Quote:

The shot does work after pregnancy when it can not possibly harm the baby.
It is said by some that it offers no additional benefit during pregnancy.
The safety concern duringpregnancy is real.  It doesn't make sense to inject antibodies into the
mother's blood stream that are designed for the sole purpose to eliminate
cells of the baby? There are numerous case reports of babies born anoxic
and asphyxiated because the RHoGam antibodies crossed the placenta during
the gestation period. This is not the only safety concern with the
injection, just the most obvious.


The problem is that injecting Rhogam during gestation you are getting
protection for your second pregnancy at the expense of your first. If you
put Rhogam antibodies into your body during your first pregnancy you are
putting antibodies against your baby into your blood stream where, if blood
mixing does occur, those antibodies will attack your baby. This is exactly
what you are trying to avoid for the second pregnancy. So, in reality you
are protecting your second pregnancy from the antibodies by injecting them
into yourself during the first pregnancy. I can't state it any better than
this: if you inject Rhogam during your first pregnancy you will prevent a
potentially harmful situation for your next pregnancy by causing that exact
same harmful situation in your first pregnancy.
 
REF: http://www.nccn.net/~wwithin/rhogam.htm

I don't know who is running nccn.net, but they don't seem to have all that great an understanding of rhogam.

I'm rh-. My first baby was also rh-. I received prenatal rhogam as a precaution (it was winter, I'd taken some falls on ice), but after the baby's blood type w as determined, we skipped the postnatal shot. I was not sensitized to rh factors when I got pregnant with my daughter, but I had placenta previa, and she was rh+. I bled at various points during pregnancy, and was given rhogam to prevent sensitization. Rhogam is a small dose of anti rh antibodies, which prevent a full scale immune response from occurring.

I had three rhogam shots during my last pregnancy, and my dd was not affected by rh incompatibility problems.

A lot of people - me included -feel really strongly about rhogam. It's saved thousands of children, mine included.
post #13 of 49
Thread Starter 

Every woman is different.  And I do believe Rhogam has helped a lot of babies.  

 

Here is an interesting article I just got finished reading.  

 

http://sarawickham.files.wordpress.com/2011/10/a1e-routine-antenatal-anti-d-an-overview-of-the-evidence.pdf

 

Has anyone read Anti-D in Midwifery: Panacea or Paradox?, By Sara Wickham ?  I do find it interesting and wondering if anyone can relate?

post #14 of 49
I haven't read the book in question. The article you link describes standard practice concerning rhogam in the UK, twelve years ago. It does not remotely describe my experiences in the US 4-5 years ago. The article argues that the apparant need for routine prenatal rhogam is an artifact of poor application of procedures for identifying and administering rhogam in response to trauma. The hospitals I dealt with had iron clad procedures to address these problems. Has there been additional research since 2001, and have the procedures in question been changed?
post #15 of 49

The shot is to keep your body from becoming sensitized if your body is exposed to babies bloody type. I had 3 shots in one pregnancy once.

post #16 of 49
I suppose I have a strong emotional feeling about Rhogam but that is because I feel really strongly that it is poorly understood by many facets of the medical community, and that includes the NCB community.

The largest benefit is definitely postnatal. Sensitization rates with zero Rhogam would be about 13% for Rh- women carrying Rh+ fetuses. Postnatal Rhogam drops that to only 1%. So you are only going from a 1% to a 0.1% risk with the 28 week shot in a low risk pregnancy.

Based on those numbers, probably as this is maybe my final pregnancy, I could have taken a calculated risk to skip the 28 week shot with zero consequences, even w/o the Fetal blood typing. IMO it depends on if you think you could deal with a future isoimmunized pregnancy & how likely you think you are to try to have one or two or more . . .

I am a huge advocate for reducing Rhogam use with Prenatal blood typing or @ least with Paternal blood type ID (as some providers give it to all Rh- women on the theory that the father could be anyone). But IMHO that is only because of a theoretical risk to the mother (specifically BSE, MadCow & then it just being a blood product), rather than any risk to the baby.
post #17 of 49
Thread Starter 
Quote:
Originally Posted by MeepyCat View Post

I haven't read the book in question. The article you link describes standard practice concerning rhogam in the UK, twelve years ago. It does not remotely describe my experiences in the US 4-5 years ago. The article argues that the apparant need for routine prenatal rhogam is an artifact of poor application of procedures for identifying and administering rhogam in response to trauma. The hospitals I dealt with had iron clad procedures to address these problems. Has there been additional research since 2001, and have the procedures in question been changed?

Hi MeepyCat :)  Fellow Cat cat.gifhamster.jpg

 

"The article argues that the apparant need for routine prenatal rhogam is an artifact of poor application of procedures for identifying and administering rhogam in response to trauma."

Did you have any thoughts on the above? Are these points in the article valid in your opinion?   If they are not valid , what research/literature can you share, maybe statistics, clinical trials etc.. can back that up?

 

"The hospitals I dealt with had iron clad procedures to address these problems"

Can you please share the Iron clad procures in detail how to address these problems you are referring to?

 

"Has there been addtional research since 2001, and have the procedures in question been changed?

To my knowledge, Rhogam from what I have researched has not changed in relation to what the article is saying.  The one obvious change was removing thimerosal starting back in 2001 that most are aware of that have researched Rhogam.  Other than that, Rhogam is still Rhogam.  A blood product.

post #18 of 49
Thread Starter 

Also, I was told by a midwife it doesn't affect your first.  Since this is my first pregnancy, getting the routine Rhogam at 28 weeks is not necessary.  She did say Rhogam is misunderstood by many, and not all woman should get/need the routine shot.   Also, in different countries of the world, it is not standard to get Rhogam at 28 weeks.  Also it may be a risk being exposed to blood products when the need is not there. The impacts on the mothers/babies immune systems still remain unknown.

 

I also have had hypersensitive reactions to flu shots in the past, so not sure if this if this blood product is necessary, if I have a healthy pregnancy, and its my first pregnancy 

 

Also, does anyone have any literature on WHY it doesn't affect your first? and more info behind that statement.  I hear it all over the place, but it is not explained why, or how valid statistically that statement is.

post #19 of 49
Thread Starter 
Quote:
Originally Posted by dinahx View Post

I suppose I have a strong emotional feeling about Rhogam but that is because I feel really strongly that it is poorly understood by many facets of the medical community, and that includes the NCB community.

The largest benefit is definitely postnatal. Sensitization rates with zero Rhogam would be about 13% for Rh- women carrying Rh+ fetuses. Postnatal Rhogam drops that to only 1%. So you are only going from a 1% to a 0.1% risk with the 28 week shot in a low risk pregnancy.

Based on those numbers, probably as this is maybe my final pregnancy, I could have taken a calculated risk to skip the 28 week shot with zero consequences, even w/o the Fetal blood typing. IMO it depends on if you think you could deal with a future isoimmunized pregnancy & how likely you think you are to try to have one or two or more . . .

I am a huge advocate for reducing Rhogam use with Prenatal blood typing or @ least with Paternal blood type ID (as some providers give it to all Rh- women on the theory that the father could be anyone). But IMHO that is only because of a theoretical risk to the mother (specifically BSE, MadCow & then it just being a blood product), rather than any risk to the baby.

 

Hi Dinahx

 

Thank you for the stats.  Much appreciated.

 

So if I get the post natal Rhogam, and opted out from the prenatal Rhogam, I'm only deciding on a 1% to a 0.1% risk with the 28 week shot in a low risk pregnancy.  If I didn't get the routine Rhogam my risk would be 1% instead, of 0.1%?

 

Now taking the risk difference of 1%  VS the Risk of  being exposed to blood products when the need is not there. The impacts on the mothers/babies immune systems still remain unknown. Rhogams saftey Information:

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. RhoGAM® and MICRhoGAM® are intended for maternal administration. Do not inject the newborn infant. Local adverse reactions may include redness, swelling, and mild pain at the site of injection and a small number of patients have noted a slight elevation in temperature. Patients should be observed for at least 20 minutes after administration. Hypersensitivity reactions include hives, generalized urticaria, tightness of the chest, wheezing, hypotension and anaphylaxis. RhoGAM® and MICRhoGAM® contain a small quantity of IgA and physicians must weigh the benefit against the potential risks of hypersensitivity reactions. Patients who receive RhoGAM® and MICRhoGAM® for Rh-incompatible transfusion should be monitored by clinical and laboratory means due to the risk of a hemolytic reaction.

 

The patient label of both RhoGam and WinRho clearly states that neither drug has ever been scientifically tested for safety on pregnant women or fetuses. With any drug made of human blood plasma, there is a slight risk of transmitting disease. So adverse reactions in both mother and fetus are certainly possible.

 

Rhogam was known to contain mercury and we all know the effects it can cause especially in the body of a fetus not even born yet, but then came the announcement that Rhogam was allegedly mercury free. But here is the catch:

If you are an Rh-negative mother, remember that, although Thimerosal-free Rho-GAM became available in 2002, the supply of mercury-containing Rho-GAM is still on the market. Remember the word “thimerosal” means it contains 49.6% mercury. This is especially important because fifty-three percent of mothers of autistic children are Rh negative, while only three percent of mothers of normal children are Rh-negative. REF: http://healthfreedoms.org/2012/02/16/why-do-53-of-autistic-children-have-rh-negative-mothers/

It is stated "Thermersol has been removed since 2001-02.  BUT Johnson and Johnson uses thimerosal in the manufacturing process, then adds a post-manufacturing process to remove the preservative...but "trace amounts" of mercury remain in the medicine. J & J admitted this in Congressional testimony a few years back.  J&J is the only brand my hosptials/doctor uses.  

 

If thermersol was in Rhogam and given to mothers by the medical industry that most trusted, why did they all of a sudden "remove it" back in 2001?.  Shouldn't really be a shock to some who wonder why we question the medical industry.

 

Although many have had the shot and all is fine, nobody can predict how one can react after the shot is given.  Nobody can prove the mother or  their baby has had some sort of reaction, or death due to the shot itself.  

 

Seems to me getting the shot over such a minimal difference compared to the possible risks of the shot isn't worth it for the baby.  Is it necessary really for MY situation? Something I have to really research.   How are the risks really outweighing the benefits having said the above?


Edited by Catmom2 - 11/25/13 at 7:28am
post #20 of 49
That is an analysis you have to make on a personal tip.

It is 2013 tho, almost 2014. There may have been residual Rhogam with 25 mcg Thimerisol on the market in say, 2003, but I read my package inserts in 2006 & it was gone. I honestly haven't dug too far into the trace residual amount issue.

Your MW was *not* correct that it *never* affects your first pregnancy. You have already identified situations ( trauma, trans placental hemorrhage) where a first pregnancy could be affected (tho the body *might* not have time to build isoimmunization to a sufficient level). Also if there have been ABO or m/c without Rhogam but with Rh+ fetuses before a first FT pregnancy . . .

It is definitely reasonable to skip the 28 week shot as the largest risk reduction is from the postnatal dose. However there are actually 'silent' cases of isoimmunization that occur between 28-40 weeks. They give the shot @ 28 weeks to cover the time of the highest amount of blood mixing. For me, the knowledge that there *will always be* some amount of blood mixing & my desire for a longer childbearing career, coupled with the actual risk of driving 1 hour @ least to MFM apts (in a future isoimmunized pregnancy) was enough for me to opt for the 28 week shot 2x & after each loss. I just didn't want to take any risk whatsoever on that tip, even tho it was only 1%.

I do however regret getting the 28 week shot in my 2010 pregnancy, only b/c I should have been able to access fetal blood typing by then & my fetus was in fact negative.
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