in depth questions regarding Rhogam given for Trauma before 28 weeks - Page 2 - Mothering Forums
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#31 of 49 Old 11-27-2013, 08:46 AM
 
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Your blood has *already mixed* with your baby's blood right now. That is what you are not really getting. You presumably have not isoimmunized. BUT your blood has already mixed. Should you suffer a trauma that would cause it to mix *more*, isoimmunization would become more likely, *unless* someone gave you Rhogam to attempt to neutralize that Rh+ blood before your body got around to it.

You could certainly play your odds. Say if your body suffered a trauma @ 34 weeks, your body would only have 6+/- weeks to attack the baby's blood & it probably would not have time to build up enough antibodies to really do a ton of damage. But it would certainly have time to build up more antibodies than are in the one dose of Rhogam that could potentially prevent your body from ever isoimmunizing. We aren't in the age where a trauma means automatic isoimmunization any more. That is *the whole purpose* of Rhogam.

And not to belabor this point, but *siblings* and a mother not sidelined with pregnancy loss or BC/Sterilization side effects certainly benefit my children . . .
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#32 of 49 Old 11-27-2013, 03:44 PM
 
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Originally Posted by Catmom2 View Post
 

 

So if trauma or  a trans placental hemorrhage happened and this is my first pregnancy, how do they tell if the blood has mixed enough where I need the Rhogam shot?  Would the Rhogam shot help the current baby (in the above particular situation), or is it just administered to help future pregnancies?  How will it help the current pregnancy if blood has already mixed?   

 

If you have a suggestion of links/literature where this is better explained, please post.

 

http://www.rhogam.com/FAQs

 

The thing with rhogam is once you are sensitized its too late and it would no longer be effective. The shot keeps your body from becoming sensitized. There are lots of things that can happen in pregnancy that sensatizes you. Just because the first prengnacy is ok all other pregnancies after that could potentially have issues.

 

 

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#33 of 49 Old 11-28-2013, 06:47 AM - Thread Starter
 
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Your blood has *already mixed* with your baby's blood right now. That is what you are not really getting. You presumably have not isoimmunized. BUT your blood has already mixed.

How exactly has my blood "already mixed" with my baby's blood right now?  What makes you say that?  Please explain.  Of course I don't get what your saying because literature points out the mothers blood and baby's blood rarely mixes during a healthy pregnancy.

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#34 of 49 Old 11-28-2013, 06:53 AM - Thread Starter
 
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Originally Posted by LLQ1011 View Post
 

 

http://www.rhogam.com/FAQs

 

The thing with rhogam is once you are sensitized its too late and it would no longer be effective. The shot keeps your body from becoming sensitized. There are lots of things that can happen in pregnancy that sensatizes you. Just because the first prengnacy is ok all other pregnancies after that could potentially have issues.

 

 

Hello  LLQ1011 :)

I understand in "theory" what it does.  It just doesn't make sense, and with all the literature research out there, a lot contradicts how it "should" work.  

 

Did you get the routine 28 week shot? Aside from if Trauma where to happen, in your opinion what do you think of Rhogam at 28 weeks during a normal healthy pregnancy?

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#35 of 49 Old 11-28-2013, 06:55 AM - Thread Starter
 
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Ps.  okay there are 2 posts that are being held by mod's since I'm new.  The first one was 2 days ago...and still hasn't been posted :(  

I just replied to LLQ1011 11/28 at 9:53am and that one is being held....just an FYI that I acknowledged your post ....hoping this one does get held to!

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#36 of 49 Old 11-28-2013, 07:09 AM
 
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They took *only* your blood but were able to count the baby's chromosomes & they were also able to determine the baby's blood type. Why do you think that is?

That is *because* some of the baby's/placenta's blood is already in your blood. The 'literature' does not say that 'maternal & fetal blood rarely mix in a healthy pregnancy'. One article by one UK Midwife may say that. It is an oversimplification. What the literature would say is that 'maternal & fetal blood rarely mix *enough to cause isoimmunization* in a healthy pregnancy, before 28 weeks.'
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#37 of 49 Old 11-28-2013, 07:26 AM
 
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Feel free to poke around PubMed.gov on this topic. That is where you would find 'the literature'. We have already explained what the exact risks are of refusing Rhogam & the rate of isoimmunization, especially in a trauma situation, but only you can make the choice.

I am personally on my 5th pregnancy & can have more without any risk of HDN. Have I gotten Rhogam when it was not strictly necessary? Yes, but only once, because 4 years ago, fetal blood typing from maternal blood was not done routinely or accessible to me . . .

Now it is accessible & you have accessed it. The next step is up to you. We definitely have isoimmunized mothers on this board, maybe you could speak with them . . .
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#38 of 49 Old 11-28-2013, 07:30 AM - Thread Starter
 
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Originally Posted by dinahx View Post

They took your *only* blood but were able to count the baby's chromosomes & they were also able to determine the baby's blood type. Why do you think that is?

That is *because* some of the baby's/placenta's blood is already in your blood.

I do understand there is a certain amount of blood that has already mixed that is okay and nothing to worry about being sensitized.  Only if your titer is measured at a "critical" amount (I can't remember off hand what the number is, if anyone does feel free to post/add to this), then you may be at risk.  Which means there are now enough antibodies in your system to potentially cause problems.  Titer levels can fluctuate.  You can have your Titer levels tested.

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#39 of 49 Old 11-28-2013, 07:36 AM
 
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It actually means that there is now enough *fetal Rh+ blood in your system* to potentially cause your body to create antibodies. Once your body starts to create antibodies, it cannot ever be stopped from doing so. Rhogam is administered only to potentially prevent your body from ever beginning to create antibodies in the first place.

Management, should your body start to create antibodies (ie become isoimmunized) would then involve testing your levels of antibodies (the titers you speak of) all the time, but just to monitor the state of the pregnancy for possible early delivery or inter uterine transfusion, etc.
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#40 of 49 Old 11-28-2013, 07:44 AM - Thread Starter
 
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Originally Posted by dinahx View Post

Feel free to poke around PubMed.gov on this topic. That is where you would find 'the literature'. We have already explained what the exact risks are of refusing Rhogam & the rate of isoimmunization, especially in a trauma situation, but only you can make the choice.

I am personally on my 5th pregnancy & can have more without any risk of HDN. Have I gotten Rhogam when it was not strictly necessary? Yes, but only once, because 4 years ago, fetal blood typing from maternal blood was not done routinely or accessible to me . . .

Now it is accessible & you have accessed it. The next step is up to you. We definitely have isoimmunized mothers on this board, maybe you could speak with them . . .

 

Thanks, I will look into pubmed.gov on the topic.   

I am considering refusing the routine Rhogam shot at 28 weeks.  I plan to get my titer levels tested at 26-27.  

In a trauma situation, I would ask them to test titer levels, if that can't be done, I would obviously get the shot in a trauma situation or medical intervention.

 

I plan to have the baby re-tested at birth (having a birth without medical intervetion)  via lab AND two eldon cards.  Your probably wondering why if I have already had the RHd  fetal genytyping done (non invasive through the mothers blood), although its highly accurate, it is not 100% nor diagnostic.

If the baby is - than all is okay.  If the baby is + then I will proceed to have my titer levels tested right away.  If they are at high levels, I plan to get Rhogam within the 72 hours after birth..  It is reccomended Rhogam  is given 72 hours after birth to be effective.  (I have heard longer) but I wouldn't chance waiting.

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#41 of 49 Old 11-28-2013, 08:01 AM
 
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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.
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#42 of 49 Old 11-28-2013, 06:12 PM - Thread Starter
 
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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.

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#43 of 49 Old 11-28-2013, 06:33 PM
 
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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.
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#44 of 49 Old 11-28-2013, 07:02 PM
 
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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.
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#45 of 49 Old 11-30-2013, 10:25 AM
 
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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.


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#46 of 49 Old 11-30-2013, 04:13 PM - Thread Starter
 
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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?

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#47 of 49 Old 11-30-2013, 06:44 PM
 
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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). 

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#48 of 49 Old 12-01-2013, 08:05 PM - Thread Starter
 
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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.  

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#49 of 49 Old 12-03-2013, 09:22 PM
 
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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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