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in depth questions regarding Rhogam given for Trauma before 28 weeks - Page 3

post #41 of 49
This post is in HomeBirth: unless you are outside the US, in any situation where you are having Titers of antibodies does as part of HDN management, you aren't in a HB situation anymore, you would likely have to be managed by a Maternal Fetal Medicine doctor, beyond even a hospital CNM or OB. So that definitely figured into my assessment: I didn't & don't ever want a MFM pregnancy if it can be avoided.
post #42 of 49
Thread Starter 
Quote:
Originally Posted by dinahx View Post

This post is in HomeBirth: unless you are outside the US, in any situation where you are having Titers of antibodies does as part of HDN management, you aren't in a HB situation anymore, you would likely have to be managed by a Maternal Fetal Medicine doctor, beyond even a hospital CNM or OB. So that definitely figured into my assessment: I didn't & don't ever want a MFM pregnancy if it can be avoided.

 

Yes, right now I am managed by MFM, and having a tough time with them.  I am currently in the process of deciding on home birth instead of medical intervention.  Why did you choose to avoid an MFM pregnancy?...just curious.

post #43 of 49
Catmom, I can't speak to why Dina prefers to avoid MFM, but for me, where we are? The only reason you wind up in MFM around here is that the risk factors have reached critical mass. If an MFM has agreed to more then a consult, it means there's a real danger to you and the baby. If it's possible to do something in one pregnancy that will lower the odds of problems in a later one, it's worth doing.

The ideal pregnancy is one in which a well-trained ordinary OB or midwife never gets excited. An MFM being interested is a good sign, in that you're getting high level care, but a bad sign in that it means you're no longer dealing with normal, or variations of normal that turn out reliably okay in nature.

The only reason my last pregnancy didn't wind up in MFM was that I started hemorrhaging twelve hours before the scheduled first appointment. I spent the seven weeks I thought would be in MFM in the NICU. I'd rather have had the baby later, even if it meant MFM care, and I'm glad that care is available, but I'm also glad when my friends and sisters don't need it.
post #44 of 49
First: let me say that if I qualified for MFM care, I personally would not dismiss them, I would continue with them. MeepyCat is right, MFM indicates you/baby have been determined to be in a high risk situation. In my situation, I would prefer to get care locally & MFM care would mean an hour drive. I meant I would rather choose PreNatal Rhogam than risk isoimmunization really. Even an MFM cannot *guarantee* a good outcome in a sensitized pregnancy, they can only monitor & attempt to prenatally transfuse or deliver early, depending. No one can predict how a woman's body will react, how quickly antibody levels will reach critical mass.

I will say in passing that HB Midwives are not typically qualified to manage pregnancies that have risked out of even regular OB care. Most/all of the ones I know & love would not even attempt it.

However IDK if your risk factors actually affect the birth itself, so I wouldn't be able to comment on that really.

Basically the bottom line is that refusing Prenatal Rhogam carries a 1% risk of isoimmunization, before, during, or after the birth. If there is trauma/bleeding that risk goes up. The risk is primarily to future pregnancies. Only you know what you want your fertility future to look like . . . As you have stated, there is very little risk to this pregnancy from refusal . . . However, there is not 'no risk'. We are stating that there is little, if any risk from getting the Rhogam to your baby. But that is a decision for you to make.
post #45 of 49

You may also want to consider your insurance situation when making this decision.  An isoimmunized friend's medical care for both her and her child ran over $800,000.  Fortunately, she had good coverage but not everyone is so lucky.

post #46 of 49
Thread Starter 
Quote:
Originally Posted by MeepyCat View Post
 

I had placenta previa, and was advised that blood mixing was likely (blood mixing with my Rh+ daughter definitely happened - they were able to ID early stages of immune response in the lab), and that it was happening early enough to potentially affect my daughter before the end of the pregnancy.  So I don't have research, just the anecdote that, in my case, there was definitely potential for it to happen.

 

Was this your first pregnancy? What ABO blood type are you and DD?

post #47 of 49

Catmom, my daughter was my third pregnancy.  I'm O-, my son (my first pregnancy) is A-, I had a miscarriage (received Rhogam within 5 hours of first bleeding, and was not sensitized), and then my daughter, who is O+.  With DD, I had Rhogam at 26 weeks, had a blood test showing considerable exposure and need for another shot at 29 weeks, and delivered at 32 weeks (more Rhogam administered post-partum). 

post #48 of 49
Thread Starter 
Quote:
Originally Posted by MeepyCat View Post
 

Catmom, my daughter was my third pregnancy.  I'm O-, my son (my first pregnancy) is A-, I had a miscarriage (received Rhogam within 5 hours of first bleeding, and was not sensitized), and then my daughter, who is O+.  With DD, I had Rhogam at 26 weeks, had a blood test showing considerable exposure and need for another shot at 29 weeks, and delivered at 32 weeks (more Rhogam administered post-partum). 

 

Hi MeepyCat  Sorry to hear about the miscarriage.

 

 I remember reading about the ABO compatibility, but haven't found much research on it.  I'm O- DH is A+, fetus is + but do not know ABO yet for the fetus.  Should be either O+ or A+ I would think more pointing toward A+.  

 

In regards to  the doctors being able to ID early stages of immune response in the lab for you, do you remember what the blood test was called specifically ?  When I had my blood screening done there was just 2.  The results said I was RH- and the other test for the "antibody screening" that had said the patient has no antibodies.   I would like to know what the test is called that measures your titer level clarifying what is in the safe zone, and when is it something to worry about.

 

I'm am also wondering what the test is called that tests for the Du Variant as well.  

post #49 of 49
I believe it is just called "antibody screen." Meaning, the amount doesn't matter, just that your body has made them (and thus has the blueprint to make more antibodies as soon as it gets exposed to the antigen). But there's also a kleinhauer-Bethe which looks for if there was actually fetal-maternal blood mixing, and that is reported as a number, although I'm only familiar with it for knowing how much rhogam to give (like, an extra dose).
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