Rhogam question

[gini1313]

So, I have a question about Rhogam. I had it during and after my first pregnancy, then after my miscarriage, then during my third pregnancy (second birth). A 28 weeks (or whenever they give it), I was not sensitized, but then when I went to the hospital (but before birth), they tested me and I was sensitized. No specific reason for it that I know of (no trauma and I had some bleeding but it was well before my first shot, so if that was it, I shoulda been sensitized then). I have seen here people saying that if you are sensitized that it does no good to give it, but they did a bunch of tests on my blood, then gave me an extra Rhogam (two of them) shot and had me come back in 12 weeks for blood tests. They did the sensitization tests again and said that I wasn't sensitized anymore. The nurse said that she has had to give 3 shots before, based on that blood work, which apparently told them how much rhogam I needed to have...

Just curious what you all have to say about that. I don't know much about sensitization or Rhogam, so have been curious about what you all would say.

[applejuice]

I am just a mom of four, trained as a CCE.

I have never heard of that.

You should have asked your caretakers for scientific evidence that doubling up on rhogam "cures" sensitization as proper protocol for treatment of your titre levels; I was under the impression that sensitization is a permanent condition. Did they tell you that rhogam is a human blood product, with all of the dangers that includes? I do know there is no evidence the 28 week shot protects for the baby you are carrying, only the next baby.

The most conservative approach is to take a cord sample at birth and give a rhogam shot to the mother within seventy-two hours of the birth if the cord sample shows intermingling of the baby and mother's blood, a situation which usually can be avoided with delayed cord clamping.

[gini1313]

I am going to call my OB and ask her about it, I haven't really thought much about it since baby was born, but have been wondering about it lately. And, yes, they did tell me it was a human product and the risks of it, but I have to admit, I didn't do much research about it.

My doc is a fabulous doctor (whom I trust with my, and my baby's, life) so I am thinking that if there is something not adding up, it is in my understanding, not in what they did. I will find out more when I call her to ask her about it. I didn't ask a whole lot of questions at the time the rhogam stuff was going on in the hospital, but if the blood work is true, and I am no longer sensitized... I can't find any info on the internet that support that, either.

Has anyone heard of this, or anything like it? I will post more after I talk with my OB. Thanks.

[MsBlack]

I can't be certain what they were talking about, but I do know this --since I just recently have been studying the whole RhoGAM/incompatibility issue:

If baby's Rh+ blood gets into Rh- mom's bloodstream during pregnancy or birth, then it becomes possible for mom's body to react by creating antibodies against the Rh factor. Probably, when they said 'sensitized', they meant that fetal blood was detected in your bloodstream, NOT that antibodies had been detected at that time. It takes time for antibody creation to commence after fetal blood gets into maternal bloodstream (3 days, at least). After any 'event' that could have caused blood mixing, tests can be run immediately to find out if there are any fetal blood cells in mom's circulation--and if there are, then testing how many fetal bl. cells are present. 'Events' would be birth, miscarriage, invasive prenatal tests (like amniocentesis), physical trauma to mother and/or a vag bleed episode whose origins cannot be determined (because it could be a placental bleed, and that could mean blood has mixed).

So, personally I think that the most intelligent and safe thing to do for all concerned is to conduct these tests before administering RhoGAM: Kleihauer-Betke (for presence of ANY fetal cells); and if KB is positive, then Rosette test (actual/estimated # of fetal cells). If no fetal cells are found, RhoGAM is not needed. But if they are found in mom's bloodstream, then it is very good to have an idea HOW MANY--because this determines the proper dosage of RhoGAM to give. Most care providers do not do any of these tests, just administer a 'standard dose' of RhoGAM to any Rh- woman during pg and following any of above 'events'. With no fetal blood cells present, again, RhoGAM is unnecessary. AND, one 'standard dose' of RhoGAM only 'covers' the 'average amt' of blood mixing (about 30 mls)--but if mom's blood contains MORE THAN 30mls of baby's blood, then she could still create antibodies after the 'standard dose'. So, knowing how much fetal blood is present helps determine how much RhoGAM to give.

there are cases of women who received RhoGAM and still made antibodies--it is understood for at least some of them, that this occurred because they were not given enough RhoGAM. Care providers made an assumption rather than testing her blood thoroughly. It is also likely that RhoGAM simply doesn't work for everyone--nothing does!

Also, if they had found actual antibodies in your bloodstream already, you would not have been given RhoGAM nor retested--since it is assumed that once mom's immune system reacts to fetal blood by making antibodies, nothing can be done. Most women are given RhoGAM without antibody screen, since it does take time for antibodies to form after blood mixing occurs, so a negative antibody screen is not conclusive--and you want the RhoGAM in the mom BEFORE she makes antibodies.

Finally, baby's blood should be typed immediately following birth--because Rh- babies will not cause sensitization leading to antibody formation, even if blood mixes. So, all of above assumes that baby is Rh+.

I hope this explains how you could be 'sensitized' then 'not sensitized'--seems that fetal blood was found in your circulation, and then RhoGAM helped destroy them before antibodies were created. You might ask your providers just what tests were conducted (not just names of tests, which may vary--but what the tests were testing for). There could have been other tests done that I am not yet aware of.

[hapersmion]

Originally Posted by MsBlack

So, personally I think that the most intelligent and safe thing to do for all concerned is to conduct these tests before administering RhoGAM: Kleihauer-Betke (for presence of ANY fetal cells); and if KB is positive, then Rosette test (actual/estimated # of fetal cells). If no fetal cells are found, RhoGAM is not needed. But if they are found in mom's bloodstream, then it is very good to have an idea HOW MANY--because this determines the proper dosage of RhoGAM to give.

That was an interesting post, MsBlack! I had never heard that before. Do you know how long the KB and Rosette tests take to come back?

Sorry to hijack, gini1313.

hapersmion

[gini1313]

Thank you, MsBlack... That makes alot of sense, and I think is what probably happened, but I am going to check with my doc and will post with the info when I get it.

When it first came up, it was the nurse talking about it during labor, then hearing her talk to the doc about it just before I started to push, so you can imagine how into asking questions I was. Then, I just sort of went with the flow, more than I usually would, after the birth, maybe because I know this particular doc so well and really trust her. I really SHOULD know what went on and my status, because although I don't plan on any future pregnancies, you never know what might happen...

(and no hijacking worries, hapersmion, more info is better )

[gini1313]

Originally Posted by hapersmion

That Do you know how long the KB and Rosette tests take to come back?

Oh, and assuming that is what they did for me, the first test came back within about an hour (based on when the nurse first said something about it) and the secod one (that they were determining how much Rhogam to give by) took a few hours.

[MsBlack]

I actually have no idea how long these tests take, but I have to assume that they could be done fast enough to be useful (less than 3 days total, since you are supposed to get RhoGAM w/in 72hrs for it to be most likely to work). I have done the reading/discussing on the topic, but have not yet had a client who chose the tests--they all choose RhoGAM if baby is Rh+, without knowing more.

And I was surprised to learn all that--this info is NOT made routinely available to Rh- families, the docs just want to give the RhoGAM and call it 'covered'.

[xelakann]

I had the test done following a car accident in August... it took around 1-2 hours... it is the counting of the blood cells that takes awhile.

They may have expedited my test due to the fact I was in a car accident. They did find fetal blood cells and I had to get the Rhogam... I will have another shot next week and one more when the baby comes.

[applejuice]

And I was surprised to learn all that--this info is NOT made routinely available to Rh- families, the docs just want to give the RhoGAM and call it 'covered'.

It is the standard of care for all Rh- women regardless of the Rh status of their partner or of the baby.

[MsBlack]

For medically managed birth, this seems to be true--just give RhoGAM, regardless of partner, baby, testing for need, etc. But then, vaccinations of all types are considered 'standard of care' in med. setting and opinion.

[hapersmion]

Yep, I never heard of any of this when I was pregnant, even though I was having prenatal care at a FSBC with CNMs. I still don't know whether ds was Rh+ or not. :

It's nice to know that there are tests like that (and they come back so fast, I'm used to medical tests taking weeks!) - I'll have to ask for those next time. Thanks for the info!

hapersmion

[Cathy422]

Thanks MsBlack!! You've given me some new ammo for my arsenal.

I'm RH-. We don't know DH's type, so of course the doc insisted on the rhogam at 28 weeks. I refused. They threw a fit. I still refused. I said if the baby was positive, then we could do rhogam after birth. Of course they couldn't force the shot, so I was left alone after that.

My main argument that made them leave me alone? Since rhogam is a blood product, I asked them if they knew if it was cleared of stuff like CMV. I happen to know I'm CMV-. (Not super common.) And since they couldn't tell me for sure, they left me alone. They don't want a pregnant woman infected with that. I still haven't found anyone who can tell me if the rhogam product can contain the CMV virus. ??? Anyone know??

I was planning on refusing the shot after birth. But I had planned a drug-free, intervention free, delayed cord cutting birth. What I got was an emergency C/S for fetal distress. (Turns out the cord was wrapped tight around his head. The midwife didn't think I could push out a first baby fast enough for him to survive.) Anyhoo... They tested the cord blood, and baby was B+. They ran a blood test on me, and then gave me a rhogam shot. I'm not sure what the tests said, but I'm pretty sure they were negative. (I'm waiting for my medical records.) I didn't object too hard cause of the traumatic birth, and because they did test my son.

I plan on the same course of action with any future pregnancies. I will refuse rhogam during pregnancy. And after birth, if baby is RH-, I'll refuse. If baby is RH+, it'll depend on the type of birth experience.

[gini1313]

I talked to my OB today. She said exactly what you said, MsBlack. So, I misunderstood and thought they were talking about me already being sensitized while they were actually talking about fetal blood in my circulation.

Thanks for the info!!!

[Mamabeakley]

It's not particularly hard or expensive to find out what your partner's blood type is. And it strikes me as just plain silly not to have that be part of the standard of care. Both DH & I are RH-, and I have never had another partner - hence, there is really no way I can be sensitized. Therefore, (assuming all my pg are w/DH, gods willing) I will never need RHOgam. Wouldn't it make sense to avoid giving a human blood product to pg women (not to mention a mercury-laden shot) when unnecessary?!!?

But the info about how it all works when it IS warranted is fascinating!