Rhogam - Page 2

[schatz]

Fact. Rhogam antibodies cross the placenta and attack the baby's red blood cells

here's my anectdote to add -- my dd who is Rh+ was born with a very low red blood cell count -- they thought they would have to give her a transfusion. I had the 28-week rhogam shot. No proof but someone would be hard pressed to convince me that the rhogam shot did not cause my dd's low blood cell count. Yes, it could be from other factors although the docs could not give me an explanation of why it happened. I opted out of the 28-week shot with my son. He did not have the problems my dd had but he is also Rh- like me. So, had I gone ahead and had the 28 week shot with my son, would he not have had the low count because he is negative and therefore the antibodies would not have attacked his cells - not sure but the catch is that you don't know the status of the baby in-utero. If you read the Cochrane review, you'll see that the antenatal shot is given at varying times depending on the country (28 weeks, 34 weeks, both) and that it reduces the risk of sensitization by about 1% (from something like 1.3% to .3%). Thanks but no thanks - I'll take the postnatal shot IF I have an Rh+ baby. JMO.

[amybw]

Thanks for this info! I have been contemplating it myself.


Amy

[Amila]

I just wanted to give my two cents about Rhogam. I agonized over this for like months. What it came down to was:

1. I was not crazy about getting a human blood product, regardless of how "small" the risks of virus transmittance are. Judging from the government's definition of "small risks" regarding vaccines I don't put a lot of faith into the CDC.

2. I felt extremely uncomfortable putting anything into my body during pregnancy, given the possible future "unknown" problems that can result for a negative girl when she decides to have children. And the fact that there are some nasty chemicals in there. AND the fact that there have never been any studies done on the possible risks to the fetus, as Rhogam is a Class C drug: http://www.safefetus.com/DrugDetail....M&TradeId=4936

(When I brought this up to my doctor, he said "There are no risks- no one has ever reported any fetal problems as a result of Rhogam" to which I replied "But there have never been ANY studies done on this" to which he replied "Well how could there be?")

3. I believe it to be pretty unlikely that mom and baby's blood mixes in the course of a normal pregnancy free of trauma or intervention.

4. I read a fantastic book (and really the only one out there) by Sara Wickham called "Anti-D in Midwifery" It is extremely scientific, gives tons of info on the actual studies done to support Rhogam (they are pathetic, few and far between, and don't even follow the scientific method). I told myself I wouldn't make a final decision until I read this book (and I am glad I did).

http://www.amazon.com/gp/product/075...Fencoding=UTF8

So I declined the antenatal dose, and got a load of crap from the doctor (I have since switched). He said I was the only person in 12 years to decline, and that I was being ridiculous and foolish. When I started feeding him statistics, he laughed and told me I can't believe everything I read, and that those numbers seem "a bit off." That is when I pulled out the package insert:

http://www.orthoclinical.com/Product...1-20-971-3.pdf

where I got my info from and flung it in his face. He certainly shut up then!

What I gleaned from the insert was that without ANY rhogam, your risks of becoming sensitized are 12-13%. With ONLY the post-labor injection, your risks go down to 1-2%. With both antenatal AND post-labor, your risks are .1-.2%.

I plan to have my baby typed after she is born, and if she is positive, then I will go ahead and get the Rhogam. In my mind, at least I am doing it because I actually know shes positive, I am only putting myself at risk, and I am taking it with the knowledge that I might actually need it because the stats for blood mixing in labor are much more real than during pregnancy. Basically I am taking a 1-2% risk.

Also, I think it is important to note that I have fully come to the understanding in my own mind that if I do become sensitized, then that is a consequence of my actions, and I still will not regret my decision. I don't feel that I can regret a decision of not potentially putting my beloved baby #1 at risk to save any future babies I might have. Other women who desire to have large families might feel differently, and that is okay too. Anyway, I hope this helps someone who may be really on the fence. I find that doing my research from government documents that SUPPORT the drugs actually aid in my decision making process (ironic as that may be).

[japonica]

[Gitti]

Bumping for someone new.

[illumini]

I know this is an old thread but I have a quick question concerning Rhogam. I have had 3 m/c's and a molar preganacy (no live babies as of now). In two of my m/c's I was not aware of my rh status and therefore did not get the shot. It was during my 3rd that I was tested and given the shot. I was also given the shot during my surgery for the molar. My doctor told me I needed to receive the shot early on in subsequent pregnancies in order to keep my body from rejecting the fetus. I never questioned him on this (but I have on plenty of other things ) Do think it will be necessary to do the shot early and then again during birth? Thanks in advance! You ladies have really helped me gather information for my future children (and pregnancies).

Lauren

[Spy]

Originally Posted by rozzie'sma

The US didn't used to do a prenatal Rhogam AT ALL. That didn't start till the 80's

I am curious what people used to do before any sort of Rhogam. Rh negative women are not exactly rare.

[maxmama]

Originally Posted by Spy

I am curious what people used to do before any sort of Rhogam. Rh negative women are not exactly rare.

Before RhoGam was available, there was a strong possibility of an Rh-discordant couple having multiple miscarriages, stillbirths and neonatal deaths or disability due to hemolysis. There are a number of non-Rh blood groups for whom this is still the case, but because their numbers are much smaller, there is no prophylaxis available. As I mentioned before, Kell (for which I am negative, and my husband is homozygous positive) is one of the blood groups for which this is the case, and I feel very strongly about the risks of HDNB and the known benefits of RhoGam.

[Peppermint]

: as I have few weeks to decide on this. I had the Rhogam during each of my other 3 pregnancies, and after my last pregnancy as he was my first + child. I a have c-section births, and during my last pregnancy had a "window" develop, I am concerned that I am at increased risk of blood mixing, but- then of course, concerned about what MT is saying about how the rhogam during pregnancy could actually attack the child I have in there now.: I have lots of reading to do in the next few weeks, and will compile some for my Dr. to read between my 24 and 28 week visits. He is a reasonable man, and not at all the normal "head in the sand" type, so hopefully he will read what I give.

[japonica]

In two of my m/c's I was not aware of my rh status and therefore did not get the shot. It was during my 3rd that I was tested and given the shot.

I'm assuming they also tested your titre levels to see if you had developed anti-D antibodies from the first 2 m/c's or else why bother getting the shot for the third one?

My doctor told me I needed to receive the shot early on in subsequent pregnancies in order to keep my body from rejecting the fetus.

That sounds off to me. From my understanding, it's intended for use after trauma or bleeding (if used at all in early pg) and is used by OBs in late pg, around 28-30 weeks to prevent sensitization in the third tri and presumably at delivery. I've not heard of OBs using it routinely in early pg if there's no sign of bleeding. Strange.

Do think it will be necessary to do the shot early and then again during birth?

No. Just my 2 cents, I would just wait until after birth, get tested, and then get the shot. But that's me. I experienced Rhogam failure (administered as it was supposed to be by health professionals), so I'm sceptical of its efficacy. Plus, now knowing what I do about how it works (and its ingredients), I would avoid it prenatally.

Before RhoGam was available, there was a strong possibility of an Rh-discordant couple having multiple miscarriages, stillbirths and neonatal deaths or disability due to hemolysis. There are a number of non-Rh blood groups for whom this is still the case, but because their numbers are much smaller, there is no prophylaxis available. As I mentioned before, Kell (for which I am negative, and my husband is homozygous positive) is one of the blood groups for which this is the case, and I feel very strongly about the risks of HDNB and the known benefits of RhoGam.

Just my perspective, but I have my doubts about it. I've met a lot of women online who were given RhoGam as indicated, and still became sensitized. So, I question its efficacy...if the OBs and health professionals know what they're doing (and women are reporting to their OBs for the shot within that 72 hour window), why are so many women still getting sensitized? Having also come through one sensitized pg successfully and chatting with dozens of women online who have also had successful sensitized pgs (not intervention-free by any means though), becoming sensitized is not the worst case scenario that OBs and nurses make it out to be. Yes, it's no picnic to have IUTs or other interventions, but getting sensitized does not equal pg loss due to HDNB. Not one of the ladies I know on the iso board has had a loss from HDNB. Some are on their third iso pg. I just met with my OB this summer. My titres are up to 1:32 already before even TTCing a 3rd child, yet neither the OB nor peris recommended against it. They did not think it was a problem to proceed. I think responsible management of iso pgs by peris and MFMs makes a huge difference in outcomes.

[rozzie'sma]

Originally Posted by Spy

I am curious what people used to do before any sort of Rhogam. Rh negative women are not exactly rare.

All I know about before Rhogam came from my grandmother. She had 4 boys, all Rh+, she is rh-. The first two boys were fine despite being "twilight births" She said how great it was, she went in they gassed and cut her and pulled them out with forceps, baby number 1 was breech too. So I am guessing from that the managment of the third stage was horrific. Baby three had jaundice but required no special treatments. Baby four had HDNB. He was a preemie and required 3 blood transfusions after birth, this was in the 50's but he lived. Basically what I am saying is that it wasn't a problem until it became a problem for the couple, then most of the time they just stopped having kids. My great grandma was rh- and had 6 babies at home UC, 4 rh+. She never had problems. Yes people have lost babies and it can be very serious, but it is not guaranteed.

[iamleabee]

The only antibody to cross the placenta is IgG. This is what the immune system eventually makes after an exposure to antigen, so that a second exposure has a rapid immunilogical response.
:
RhoGam is an IgM anti-D immunoglobulin that binds to the D antigen and eliminates it from the body, thus preventing the maternal immune system from seeing it and forming IgG antibodies against it. The difference is that IgM antibodies are too large to cross the placental barrier, and therefore cannot harm the fetus (they contain 5 subunits), whereas IgG antbodies are small and do cross the placenta and attack fetal RBCs.

:

[mamakay]

Originally Posted by iamleabee

The only antibody to cross the placenta is IgG. This is what the immune system eventually makes after an exposure to antigen, so that a second exposure has a rapid immunilogical response.
:
RhoGam is an IgM anti-D immunoglobulin that binds to the D antigen and eliminates it from the body, thus preventing the maternal immune system from seeing it and forming IgG antibodies against it. The difference is that IgM antibodies are too large to cross the placental barrier, and therefore cannot harm the fetus (they contain 5 subunits), whereas IgG antbodies are small and do cross the placenta and attack fetal RBCs.

:

Oooh...that makes sense.
I always thought RhoGam sounded a little counter intuitive. But I get it now. Thanks.

[maxmama]

Originally Posted by iamleabee

The only antibody to cross the placenta is IgG. This is what the immune system eventually makes after an exposure to antigen, so that a second exposure has a rapid immunilogical response.
:
RhoGam is an IgM anti-D immunoglobulin that binds to the D antigen and eliminates it from the body, thus preventing the maternal immune system from seeing it and forming IgG antibodies against it. The difference is that IgM antibodies are too large to cross the placental barrier, and therefore cannot harm the fetus (they contain 5 subunits), whereas IgG antbodies are small and do cross the placenta and attack fetal RBCs.

:

Thank you for your explanation. All I could remember (pp brain) was that the IgM was too big to cross. Your explanation is much clearer!

[rndasie]

Forgive me for coming in late and I haven't read all the posts, but I also understand that with the incompatibilty in rh factor that the antibodies of the mother can view the fetus as a predator and begin attacking it thus causing an abortion or premature labor. any bleeding during pregnancy will result in the mother receiving a RhoGam shot as the docs take that at some point the protective barriers may become compromised.

So my description of why you may receive a RhoGam may not be what you were looking for a may be a bit incorrect, as this only comes from what I was told by several OB's.

[Peppermint]

Originally Posted by iamleabee

The only antibody to cross the placenta is IgG. This is what the immune system eventually makes after an exposure to antigen, so that a second exposure has a rapid immunilogical response.
:
RhoGam is an IgM anti-D immunoglobulin that binds to the D antigen and eliminates it from the body, thus preventing the maternal immune system from seeing it and forming IgG antibodies against it. The difference is that IgM antibodies are too large to cross the placental barrier, and therefore cannot harm the fetus (they contain 5 subunits), whereas IgG antbodies are small and do cross the placenta and attack fetal RBCs.

:

Don't duck, everyone here wants the TRUTH. That is what we do here. I was hoping you have a link or something to explain this, so I can really research it, only 4 weeks now until I am due for my injection. TIA!

[wasabi]

Originally Posted by SaraFR

Is it just as effective to get no shot during the pg. but get one postpartum IF the baby ends up being pos.?

Yes it is.

They give us the shot at 28 weeks because the shot only lasts for 12 weeks and theoretically we're all going to give birth right smack on the dot at 40 weeks right? The risks of a microbleed are very low and barring a major trauma or event there's no reason to think you're more likely to have a microbleed in the last 12 weeks of pregnancy than in the preceeding 28 weeks. There is also evidence that suggests that it would take 13 such microbleeds to actually build up enough sensitization as the major mixing that can occur during labor with modern birth practices. There's a really good website out there that lays a lot of this out but I don't have it saved any more because I've switched computers since I was making this decision last time. You might do a search for old threads about Rhogam. With my first three pgs I did have the prenatal shot and then for two pgs had the postpartum shot (DS was RH- as I knew he would be since his father was negative but hey they only had my word for it ). With the last pg I did my research and felt comfortable forgoing the prenatal shot. DD was born without incident and I had the postpartum shot. My feeling was that the postnatal shot only provided a risk to me whereas the prenatal shot was a risk to her. I felt better not risking the possibility of sensitization once she was out of me.

[wasabi]

An older thread with good info though still not the link I was looking for.

http://www.mothering.com/discussions...14#post6907914

[maxmama]

Originally Posted by wasabi

Yes it is.

No, it's not.

I was sensitized to Kell during my first pregnancy -- negative antibody screen at 6 weeks, positive at 28 weeks. No known trauma, no known placental bleeds. Frankly, I would take what I view to be the negligible risks of blood-borne pathogens related to RhoGam over sensitization.

[wasabi]

I honestly don't know what Kell is but I do know a lot about Rh sensitivity. I have no idea if Kell sensitization is harder or easier to achieve during a normal pregnancy than RH sensitization. As I mentioned previously it is thought that it would take multiple microbleed to achieve actual RH sensitization I have no idea if the same is true for Kell. However if you were positive at 28 weeks and we subsitute RhoGam for Kell then you would still have been sensitized because you don't get the shot until 28 weeks. As I believe a previous poster mentioned your case actually proves the problem with the idea of giving the shot at 28 weeks preventing prenatal sensitization because you would have been sensitized before your prophalactic shot. There is a 1.8% chance of prenatal RH sensitization and that includes all women even those who were involved in severe traumas that put them squarely at risk for a microbleed. Again I have no idea what the risk is for Kell relative to the risk for prenatal RH sensitization. If I assume that it is similar to the risk of RH sensitization then you have to weigh whether or not being in that tiny tiny group (well less than 1.8%) is worth it or not. In my case I judged it was not worth it. In your case you're saying it would have been worth it. Just as in all cases where something is extremely low risk it doesn't matter if that .05% is you and I get that. But I think it is important to present facts about the risk and let people make their own judgements. In the huge, vast marjority of cases women who go through a normal pg with no spotting or trauma are just as well served getting a postnatal shot if the baby is positive.