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Originally Posted by doulaspirit  Greetings! I am 12 weeks pregnant with my first baby. During my initial prenatal blood work, my CNM told me they discovered that I have E antibodies in my blood. We are currently in the process of testing my husband to see if he has the E antigen. If he doesn't, everything is perfectly normal and fine. If he does, she advised I would need to be referred to a maternal fetal specialist.
Does anyone have experience with this? I believe it's somewhat similar to the Rhesus (Rh D) sensitivity, just a different type.
I was considering a homebirth, but I assume if my husband tests positive for the antigen, that's no longer a possibility. Can anyone give me tips on trying to maintain a natural, low-tech pregnancy/birth while being "high-risk?"
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I have anti E, and I'm 20 weeks preg. I found out just as I was about to push my son out during my last labor that I had it. His Coombs (I may have spelled that wrong) test was negative, but he still had very high billi levels of about 21 at 3 days old. And it rose wicked fast, too. At 2 days old it was a 6, and the very next day it was 2 point something. I don't remember how high the decimal got. My milk came in fast and he was a voracious eater, so his cleared within a week or so with no further intervention than a billi blanket.
You may need to consult with a MFM, but they do not need to do your primary care. I usually find Peri's and MFM's to be more relaxed about stuff in general than OB's who are in fear of everything, but that is just my experience. I also have a blood clotting problem and have had multiple losses, so I'm high risk anyway.
The general standard of care is to check titers every trimester. If they appear to be in the rise, then you may need to have them checked more often. Also, you will need an u/s of the middle cerebral artery. How often depends on your titers and how conservative your OB is. It is a good indicator of how well the baby is doing. You will also need regular growth scans into the third trimester to check for swelling of the fetus. If your titers are high, your MCA u/s looks bad, and there is swelling, they will probably do an amnio. Maybe even multiple amnios, and if worst comes to worst possibly an inutero exchange transfusion, or premature delivery. More than likely it will not come to that. The literature also supports delivering by 38 weeks to reduce the risk of still birth. I will probably opt for that myself, but my first 2 were 4 and 3 weeks early respectively, so I feel like I will deliver naturally by then.
After the baby is born, you guys are looking at a hospital stay. Sorry. They will check the cord blood of the baby, and they will check the billi at (I think) 6 hours of life and often after that. They will also need to do draws for anemia. I know these things are a given for my kids since they both had severe jaundice, and my oldest was not a sensitized preg. I'm hoping that a 3-4 day stay will be sufficient, but if the baby is breaking down the RBC's too quickly and ends up with severe anemia then an exchange transfusion will need to occur.
Other than that stuff, you can do a pretty natural pregnancy and delivery. For the most part, you just need to be watched. A lot of what I mentioned is the worst case scenario, so you know what to expect. But if your titers don't rise, and if your baby does not start to swell or become anemic, then you won't need to do any of those things. I would not delay cord camping, personally, since the more RBC's there are to hemolyze, then the higher the billi levels can get. I would do regular u/s, if I were you, just to keep an eye on things. The results of being anti E can be bad, but with the right expectant management and the right care, that rarely happens.
Good luck to you. I know I was devastated when I found out I had it, but I've come to terms with it more now.
