Rhogam- I'm so confused! - Mothering Forums

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#1 of 26 Old 12-17-2010, 07:06 PM - Thread Starter
 
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I'm Rh- and my husband is Rh+, and I'm about 6 weeks pregnant with our 1st child. I do not want to get the Rhogam shot prenatally, and only want to get it after the birth if it's absolutely necessary. My mom's a GP and has been giving me lots of...facts about why I need a rhogam shot. She told me that if my mother was Rh+, then I would have been sensitised at birth and therefore need the Rhogam shot both at 14 and 28 weeks. She also said that the mother's blood and the baby's blood is always mingling, and this doesn't just happen during trauma. I was really confused about this because I thought that the Rhogam shot would be useless if the mother was already sensitised? I also thought that the baby's blood only mixed with the mother's if there was trauma or during birth? Also, I have heard that if you have a natural childbirth, it is less likely for the baby's blood to mix during birth. Is there any way of knowing if this has happened for sure after the birth other than by doing a blood test? How does the mother's blood mix with the baby's during birth usually, and why does a natural birth make a difference?

 

I'm getting so much conflicting information about this, and it's been really hard to weed out what's true and what people are simply telling me to get me to take the shot. Help!

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#2 of 26 Old 12-18-2010, 10:28 AM
 
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There is only book book on the subject, Anti-D in Midwifery, I would highly suggest getting a copy of it. Yes, the chance of mixing blood is decreased with natural birth, the book details things. Pulling the the cord/placenta should be avoided, etc... The more interventions mean the higher the chance of mixing of the blood between mom and baby. There is a low risk of being sensitized during pg if there is no major trauma, other countries do not offer the Rhogam prenatally. The mom and baby's blood do not intermingle all the time. 

 

I have accept and declined rhogam after birth for various children based on my thoughts if I needed it or not. I do not take it prenatally. 


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#3 of 26 Old 12-18-2010, 10:35 AM
 
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Search in the homebirth forum (and other forums) for Rhogam.  There are lots of us RH- mamas, and lots of experience, advice, and resources. 

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#4 of 26 Old 12-18-2010, 11:47 AM
 
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I beleive it's only an issue if you plan to have more than one baby.  The first baby will sensitize you, and therefore put future babies at risk.  Is there a reason you are avoiding it?  I was able to but only because dh is also rh negative.

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#5 of 26 Old 12-18-2010, 12:10 PM
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I feel strongly about Rhogam being awesome and lifesaving.  However, absent any kind of abdominal trauma or increased risk of bleeding, I don't think you absolutely have to get it before birth.  Think about your lifestyle and your concerns, and decide for yourself. 

 

This is the first I have ever heard of the suggestion that Rh- women need a 14 week shot.  Overall, your mom's info sounds off.  Maternal and fetal blood do not mix all the time.  Rh+ women can sensitize their Rh- children at birth, but it's rare.  Many doctors think the sensitivity wears off over time if the child isn't re-exposed.  There is a blood test for Rh sensitivity that you can take if your mom is making you concerned.  FWIW, I was sensitized at birth and had an immune reaction.  At my pediatrician's advice, my mom started warning me that I might not ever be able to have children around the age of 6.  She was well-intentioned, but I think that might have been overkill.  I tested negative for Rh sensitivity at age 23.  (And my kids are fine, but it turns out my dh is also Rh-, so that doesn't reveal anything about my Rh status.) 

 

I don't know the answers to all your questions about maternal-fetal blood mixing during birth and why natural childbirth decreases risk.  I think, though, that you should end this line of conversation with your mother.  This sounds like a situation that calls for bean dip. 

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#6 of 26 Old 12-19-2010, 10:43 AM
 
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Rhogam after birth when the baby is confirmed Rh+ is one thing. I think that there is some merit to it and that it warrants looking into it before dismissing it. My take on it was to make the final decision based on the circumstances of the birth.

 

Prenatal rhogam, however, is not supported by evidence. The package insert (for the Canadian version at least) even specifies that it is not tested or proven safe in pregnancy and that it should only be given when the benefits outweigh the risks. I guess it might be worth doing if you are in a car accident or something similar.

 

You should also look into what happens if you do end up being sensitized. The reality is that, while it can sometimes be deadly, it generally only warrants closer monitoring in future pregnancy.


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#7 of 26 Old 12-19-2010, 11:04 AM - Thread Starter
 
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Thanks everyone. I'm still really confused about rhogam but hopefully I'll be able to clear things up a bit when I talk with my midwife and doctor. I've been looking for the Anti-D book, but I've been having a hard time trying to find a copy for under $50. I guess I'll make the investment though...

 

I'm hesitant to put anything like that in my body when I'm pregnant, and I have a pretty big phobia of needles which are the two main reasons why I'm avoiding it. I'll probably end up getting it after I give birth if the baby's Rh+ just in case, but honestly I just don't understand why it's needed during pregnancy if the only time you would need it is if trauma happened causing your blood to mix, in which case you have 72 hours to get the shot.

 

Thanks girls, I'll be heading over to the home birth forum!

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#8 of 26 Old 12-19-2010, 11:19 AM
 
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Quote:
Originally Posted by RabbitMomma View Post

Thanks everyone. I'm still really confused about rhogam but hopefully I'll be able to clear things up a bit when I talk with my midwife and doctor. I've been looking for the Anti-D book, but I've been having a hard time trying to find a copy for under $50. I guess I'll make the investment though...

 

I'm hesitant to put anything like that in my body when I'm pregnant, and I have a pretty big phobia of needles which are the two main reasons why I'm avoiding it. I'll probably end up getting it after I give birth if the baby's Rh+ just in case, but honestly I just don't understand why it's needed during pregnancy if the only time you would need it is if trauma happened causing your blood to mix, in which case you have 72 hours to get the shot.

 

Thanks girls, I'll be heading over to the home birth forum!


I've read that in the past that women in Western Europe were only given the post-partum shot and did not have higher rates of sensitization.


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#9 of 26 Old 12-19-2010, 04:04 PM
 
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Originally Posted by RabbitMomma View Post

I'm Rh- and my husband is Rh+, and I'm about 6 weeks pregnant with our 1st child. I do not want to get the Rhogam shot prenatally, and only want to get it after the birth if it's absolutely necessary. My mom's a GP and has been giving me lots of...facts about why I need a rhogam shot. She told me that if my mother was Rh+, then I would have been sensitised at birth and therefore need the Rhogam shot both at 14 and 28 weeks. She also said that the mother's blood and the baby's blood is always mingling, and this doesn't just happen during trauma. I was really confused about this because I thought that the Rhogam shot would be useless if the mother was already sensitised? I also thought that the baby's blood only mixed with the mother's if there was trauma or during birth? Also, I have heard that if you have a natural childbirth, it is less likely for the baby's blood to mix during birth. Is there any way of knowing if this has happened for sure after the birth other than by doing a blood test? How does the mother's blood mix with the baby's during birth usually, and why does a natural birth make a difference?

 

I'm getting so much conflicting information about this, and it's been really hard to weed out what's true and what people are simply telling me to get me to take the shot. Help!


 
I can see that you are confused!  I'm confused by your post: you said that your mom is a GP, and that your mom said to you 'if your mother was Rh+'....um, huh???  If the GP is your mom, then why is she uncertain about the Rh type of your mom...I guess adoption, maybe?

 

Anyway--whoever it is telling you this info, she is very wrong.  The mother's and baby's blood is NOT always mingling!  The system for all women/babies is designed so that nutrients and wastes are exchanged across placental membrane.  Mother's blood stays on one side of that membrane, baby's blood stays on the other.  Only some sort of injury/trauma to you, leading to rupture of that membrane (even if only in a small area), causes baby blood to get into mom's bloodstream.

 

All of the way you understand this is completely wrong.  Maybe she just wasn't good at explaining it?  Anyway, yeah, there are many threads here on Rh factor and rhogam--that make the facts and viewpoints much more clear.

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#10 of 26 Old 12-19-2010, 04:49 PM
 
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To those people saying only the US does prenatal Rhogam and that Europe does not--NHS standard practice is to give it:

 

http://www.nhs.uk/Conditions/Rhesus-disease/Pages/Prevention.aspx


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#11 of 26 Old 12-20-2010, 09:53 AM - Thread Starter
 
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Yes I was adopted so I don't know my birth mother's blood type sorry rereading my first post that was a tad bit confusing! I think my mom might have embellished about a few things to get me to take the shot. Honestly I'm not entirely sure she knows what she's talking about with Rhogam, only that she's been told/taught that it's necessary postnatally but not why.

 

Okay, one more question. Is the prenatal Rhogam recommended for mothers who have already given birth? This is my first pregnancy, but I've been hearing that the prenatal Rhogam is not needed for first time mothers. Is it needed after that, or only if you are sensitised during your first pregnancy?

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#12 of 26 Old 12-20-2010, 10:11 AM
 
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RabbitMomma, if you're sensitized during your first pregnancy, you need much closer monitoring and more intensive treatment during subsequent pregnancies (unless you're lucky enough to have all Rh- babies). 

 

The time when exposure and sensitization most commonly occur is at birth.  There are situations in which exposure may occur earlier - if you experience any bleeding or abdominal trauma, or if there is any reason to believe that blood may be mixing internally, then sensitization can occur during pregnancy.  However, the current pregnancy is usually not affected.  The shots are intended to prevent sensitivity from developing in the first place.  Once you are sensitized, Rhogam won't help you.

 

Prenatal Rhogam is recommended for Rh- mothers, whether or not they have previously given birth.  (Whether you choose to take the recommendation is up to you.)

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#13 of 26 Old 12-22-2010, 07:36 AM
 
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There is a new blood test that can determine your baby's blood type while you are still pregnant. You can take it starting at 9 weeks. There is only one lab that does it, though, so it has to be sent there. If your baby is Rh-, then the Rhogam shot is definitely not necessary. If your baby is Rh+, then it's possible that you could be sensitized, which could adversely affect future pregnancies. I consider the chance of being sensitized during pregnancy to be so small that I choose not to get the prenatal rhogam... even if I found out the baby was Rh+. I would get the postnatal shot if I had an rh+ baby, even if it means going to the doc's office a couple days after a homebirth.

 

Your mother's information doesn't make sense. You can get a blood test to determine if you are already sensitized... and if you are, Rhogam will not help. It only prevents sensitization, and needs to be given within a couple days of the sensitization exposure.

 

I know there are a lot of other threads with all the links, including the one about the blood test to determine blood type (the test also tells you gender of the baby, btw).


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#14 of 26 Old 12-22-2010, 10:54 AM - Thread Starter
 
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Thanks Honeybee, I'll definitely look into that test. Do you know how early in the pregnancy you can take it?

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#15 of 26 Old 12-28-2010, 01:09 AM
 
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You should also look into what happens if you do end up being sensitized. The reality is that, while it can sometimes be deadly, it generally only warrants closer monitoring in future pregnancy.

 

 

Yup...I had two successful sensitized pregnancies after a case of prenatal winrho failure. Both of my subsequent children were fine. I did need to see a peri team during both pregnancies, but no major issues arose and no major interventions were needed (IUTs, etc.)


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#16 of 26 Old 12-30-2010, 06:42 AM
 
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With this pregnancy I was tested early on for RH sensitivity to verify that the last pregnancy did not result in sensitivity.    I am RH- and DD was RH+.   I can't remember if this test was done with my first pregnancy or not but you could ask about it.  That would put to rest any concerns about your being sensitized already from a possible RH + mother.


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#17 of 26 Old 12-30-2010, 09:55 AM
 
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OP - your initial bloodwork will include a test for RhD sensitivity since you are RhD-.  The actual test is called an indirect Coombs test, but I think on the lab paperwork it has another name because they also test for other antibody incompatibilities.  If this tests comes back negative, then you are not sensitized, from either your own birth with a possible RhD+ mother or from a previous pregnancy where the baby was RhD+.

 

If the test shows you are sensitized, your pregnancy will be monitored more closely, as PP mentioned, unless you opt (and pay for?) the early test to determine the in utero baby's blood type.  I don't know how invasive this test is though (do they insert a needle?  eek!), or if there is any risk for the fetus.  I don't know much about the test, I would like for someone to fill us in here! 

 

If the test shows you are not sensitized, the protocol for RhD- mothers with RhD+ partners in the US (used to be?) one shot at 28 weeks, and another within 72 hours after the birth.  Additional doses are recommended in certain situations, ie abortion or threatened or actual miscarriage; invasive testing like CVS, amniocentesis, etc;  after an external version; etc.  The manufacturer of the main formulation used in the US, Rhogam, says that the shot lasts for 12 weeks, although I am not sure where this data came from.  So, by this reasoning a 28-week shot and a post-birth shot would provide continuous coverage (up to the limits of the shot) from the 28-week mark onward.  It's not quite this simple, since the Rhogam shot is "dosed" to provide protection for a certain amount of exposure to fetal RhD+ blood (up to 15 mL).  If a mother experiences blood mixing that is in excess of this upper limit for the dose (for example, trauma to the stomach, car accident, etc), then it is possible that some of baby's RhD+ cells will remain in circulation after the anti-D in the shot has been expended and will cause the mother's immune system to sensitize to the RhD antigen.  Also, I believe that some women who are exposed to a large amount of blood mixing may not become sensitized, while others who are exposed to only a small amount of blood mixing do become sensitized.  Just as with everything in nature, I believe it is a highly individual and difficult-to-predict process in an individual woman.

 

According to the University of Connecticut Health Center, ACOG recommends repeated doses of Rhogam to pregnant women every 12 weeks while they remain undelivered.  I can't find the ACOG bulletin where the recommendation was actually made, so I don't know when this protocol should start (according to ACOG).  But, this may be the source of your mom's recommendations for 14 and 28 weeks (official Rhogam dosing instructions still put 28 weeks as the time of first dose unless there are other factors mentioned above).  That would put dosing at every 14 weeks, which is a couple weeks outside the 12-week recommendation.  Dosing at (12, 24, and) 36 weeks could lead to the newborn testing positive on the direct Coombs test at birth.  The direct Coombs test is a different test from the indirect test.  In general it measures if an infant has been exposed to anti-D antibodies, presumably from the mother's blood, and needs a transfusion after the birth.  However, if a mother receives Rhogam very near the time of birth, it is possible that the test could come back positive and require transfusion for the newborn, because the Rhogam shot itself can attack (baby's) red blood cells that have RhD antigen on them.

 

The original data on anti-D (Rhogam) came from experiments that were done on inmates several decades ago.  They injected RhD- men with RhD+ blood and then measured sensitization with and without the prophylaxis.  This became the basis of the original dosing recommendations and intervals.  IIRC, the inmates were injected on a Friday, and they couldn't access them again to test until the following Monday, so that is where the 72-hour rule following childbirth came from.  AFAIK there have been no other studies to determine exactly how long a woman has to get the anti-D shot to prevent isoimmunization, and I am sure it is an individual thing.  I believe that most physicians recommend that mothers who miss the 72-hour window still receive the shot within 4 weeks of birth, but there is no data to determine how effective the shot at this point would be.  IIRC the average rate of isoimmunization for an RhD- woman with a RhD+ baby in the absence of ANY Rhogam is 13% (meaning 87% will be fine and their body will not mount an immune response).  For women who receive the post-birth shot ONLY and not the prenatal shot, the incidence drops to 1-2% (98-99% will not mount an immune response).  For women who receive the shot at 28 weeks and the post-birth shot, the incidence drops to 0.1-0.2% (99.8-99.9% will not mount an immune response).

 

Another thing to consider is that the anti-D shot is derived from human blood plasma and therefore has all the risks of a blood product.  I don't know if anyone has actually ever had a disease transmitted due to the anti-D shot, but the risk is still there, however small.  Also, some people are not comfortable with injecting another person's blood product into their body for other reasons.

 

It's a complex situation, and I don't think there is one "right" answer for every woman.  Rhogam has helped to reduce the rates of hemolytic disease of the newborn since the 60's when it was introduced.  I personally opted out of Rhogam completely with my first daughter.  I was not sensitized following that pregnancy, but we also do not know her blood type.  This time I purchased two Eldon cards to test the blood of the new baby as well as my first child.  I believe my midwife will also order a lab test to verify baby's blood type from cord blood.  If it is positive, I am not sure what I will decide.  I may still forego post-birth Rhogam. 

 

Good luck to you, however you decide.

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#18 of 26 Old 12-30-2010, 10:01 AM
 
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For some reason the link didn't work.  Here it is: http://health.uchc.edu/clinicalservices/maternal/rhogam.htm

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#19 of 26 Old 12-30-2010, 10:18 AM
 
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Originally Posted by RabbitMomma View Post

I'm Rh- and my husband is Rh+, and I'm about 6 weeks pregnant with our 1st child. I do not want to get the Rhogam shot prenatally, and only want to get it after the birth if it's absolutely necessary. My mom's a GP and has been giving me lots of...facts about why I need a rhogam shot. She told me that if my mother was Rh+, then I would have been sensitised at birth and therefore need the Rhogam shot both at 14 and 28 weeks. She also said that the mother's blood and the baby's blood is always mingling, and this doesn't just happen during trauma. No, the mother and baby's blood is not continuously mingling, but it is possible that the mixing could occur at any time throughout the pregnancy or birth.  I was really confused about this because I thought that the Rhogam shot would be useless if the mother was already sensitised? This is correct.  I also thought that the baby's blood only mixed with the mother's if there was trauma or during birth? Those are the most probable times/reasons for blood mixing to occur.  Also, I have heard that if you have a natural childbirth, it is less likely for the baby's blood to mix during birth. I believe this is true, but I don't have any scientific research to back it up.  Is there any way of knowing if this has happened for sure after the birth other than by doing a blood test? No, the blood test is the only way to know for sure.  How does the mother's blood mix with the baby's during birth usually, and why does a natural birth make a difference?  As the placenta shears from the uterine wall, it is possible for blood mixing to occur, especially if the placenta is abnormally attached to any degree for any reason (eg, placenta accreta).  There may also be risk of blood mixing if the uterus is over-stimulated in any way, naturally or from synthetic pitocin, which could case a small degree of placental separation.  Also, I believe that medically managed birth, especially third stage, increases the likelihood of blood mixing.  Cord traction, fundal pressure or massage, pitocin, etc disrupts the physiological separation mechanism and (I believe) increases the risk.  Then again, a completely physiological third stage could still have blood mixing, to a small degree.  For women who are especially prone to become sensitized, this could be enough to push them into isoimmunization.  The 87% figure above is, I am sure, from women who have had hospital births with medically managed third stage.  I don't know what the rate is, or if it is different, for physiological third stage without any anti-D shot.

 

I'm getting so much conflicting information about this, and it's been really hard to weed out what's true and what people are simply telling me to get me to take the shot. Help!



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#20 of 26 Old 12-30-2010, 10:26 AM
 
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Originally Posted by RabbitMomma View Post

Yes I was adopted so I don't know my birth mother's blood type sorry rereading my first post that was a tad bit confusing! I think my mom might have embellished about a few things to get me to take the shot. Honestly I'm not entirely sure she knows what she's talking about with Rhogam, only that she's been told/taught that it's necessary postnatally but not why.

 

Okay, one more question. Is the prenatal Rhogam recommended for mothers who have already given birth? It is recommended for any RhD- pregnant woman who is not already sensitized, unless her partner or the baby are known to be RhD-, regardless of how many times she has been pregnant or given birth.  This is my first pregnancy, but I've been hearing that the prenatal Rhogam is not needed for first time mothers. It depends what you mean by "needed."  If a woman is sensitized during her first pregnancy with a RhD+ baby, then her lab work will reflect that for future pregnancies, and her future pregnancies will be more closely monitored for hemolytic disease of the newborn (HDN).  I think it is unlikely that a woman would become sensitized early in the pregancy with a first baby, and that baby would go on then to develop HDN before birth.  So getting Rhogam with your first pregnancy with a RhD+ baby is not intended to protect that baby, but to protect future RhD+ babies you may carry. Is it needed after that, or only if you are sensitised during your first pregnancy? If you are sensitized, Rhogam is useless for prevention of HDN, and monitoring is required.  As long as you remain not sensitized, the protocol for getting Rhogam is the same regardless of how many babies/pregnancies you have had.



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#21 of 26 Old 12-30-2010, 04:00 PM
 
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If the test shows you are sensitized, your pregnancy will be monitored more closely, as PP mentioned, unless you opt (and pay for?) the early test to determine the in utero baby's blood type.  I don't know how invasive this test is though (do they insert a needle?  eek!), or if there is any risk for the fetus.  I don't know much about the test, I would like for someone to fill us in here! 

 

If the initial screen indicates you are sensitized, then the OB will likely do a couple of subsequent screens over a period of weeks to check if it's a false positive from the rhogam shot or to see if the titer starts to rise (which will indicate true sensitization). This happened in my case, My initial one was positive in my first tri prenatal b/w and when I went back for a follow up screen, my titer turned out to be 1:2. 

 

If true sensitization has occurred, the OB will also do a blood draw on the father to check for his genetic profile for that particular Rh antigen (in this case, D). If he's homozygous for D, then the baby will be positive for D and affected (to whatever varying degrees) by the antibodies. If hubby is heterozygous for D, then that means one positive gene and one negative one, and there's a 50% chance that the baby will be negative for D and unaffected by the maternal antibodies. I know Honeybee mentioned the blood test. The peris I saw (or the OB) never mentioned it (I think it's a relatively new option). The standard has usually been (for babies with heterozygous dads) to do a cordo at about 19w and check the baby's blood type at that time (I don't think cordos can be done earlier...the peris I saw said that they don't transfuse earlier than 19w just because of how small the cord is at that point). If the baby is negative, then it's a normal pregnancy from there out. If the baby is positive, then the peris/MFM team continue monitoring with regular MCA (mid cerebral artery) dopplers, transfuse if necessary with intrauterine transfusions, and try to get the pregnancy past 34w. Of course, no two sensitized pregnancies are alike. Some moms have very little interventions besides monitoring and induction near term (that was my case, I made it to 37w with no transfusions both times) while others have 8-9 IUTs and delivery at 34w with a lot of postnatal care afterwards. I don't advocate for or against rhogam as it's an individual decision...it didn't work in our case (large silent bleed between 32w and delivery that the prenatal dose couldn't counteract), but it's good to know that in this day and age, sensitized moms can still have successful pregnancies.


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#22 of 26 Old 12-31-2010, 09:59 AM - Thread Starter
 
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Thank you everyone for all the info, it was so helpful! I will be meeting my midwife for the first time next week and plan on asking her opinion on Rhogam, so hopefully I'll get more info then. I sent the Anti-D book to my husband's house and he said the info was very interesting so I'm itching to get my hands on it once I move next week.

 

I have one more question. I told my mom that I was planning on not having the prenatal shot but taking the test to see if I was sensitised. She told me that the test wasn't very accurate, especially since I was relatively young (22). She also seems to be under the impression that Rhogam should be given if you are already sensitised, so I don't think she quite knows her facts about Rhogam. Either that or she's trying to scare me into getting the shot. irked.gif Anyway, is there any truth to the test to see if you're sensitised not being accurate?

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#23 of 26 Old 12-31-2010, 03:06 PM
 
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I've never heard of the test being completely inaccurate...there are a couple of situations though that can affect its perceived reliability. First is what I described with knowing whether it is true sensitization or the remnants of the rhogam giving a false positive. But that can be determined over time with subsequent testing.

 

Second, I have heard from other iso moms that their titer levels would sometimes vary if they went to different labs. For example, they'd be 1:4 at one lab and have a repeat done that same week and be 1:8 elsewhere...That's why we'd always recommended to new iso moms that they use the same lab for consistency's sake. I think all titer tests in my city were done by one central organization anyway (in my case, Canadian Blood Services) as it was their requisition.

 

The erroneous idea of giving rhogam post-sensitization is unfortunately all to common. I encountered it all the time in my OB's office. With my second iso pg, I had one of the nurses phone me to come in for my 28 week shot. The conversation went like this:

 

"Why?"

"It's because you're Rh negative. You need the shot to stop developing antibodies against the baby."

"I see. The antibodies I already have. The ones you fill out the titer requests for? The ones I see the peri about?"

Pauses. "Um, yeah."

"So you want me to come in to get a shot to prevent something I already have?"

Giggles. "That doesn't make sense, does it? I guess you don't need it after all."

 

I had to argue with nurses both in the OB's office and in hospital during both pregnancies that I didn't need a winrho shot. You'd think that they'd have a greater understanding of some of this stuff. I think many of them are just going through a routine (Rh negative = rhogam) and don't actually consider it any further than that.


Mother to DD#1  s/b @40w 2003 for unknown reasons; DD#2   9.5 years old; DS  6 years old 
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#24 of 26 Old 01-01-2011, 07:58 AM
 
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I am rh+ but I have been sensitized to a different rh factor. There is no rhogam equivalent for what I have, but if there was, I would have gotten it. We're not sure when it happened, but it was some time during my second pregnancy. We found out after the delivery, so it happened sometime during the pregnancy. There was no "trauma" during my pregnancy at all, so it's a mystery how it happened. My son had very severe jaundice, but got through it OK. His billi numbers were about 23 at 2 days of life.

 

Now, every pregnancy has to be monitored very closely. The risks of fetal death are very high, if your partner is homozygous that is. Mine is heterozygous, so we have a 50/50 chance of our kids being affected. You don't know until birth, so the pregnancy is considered high risk. I have to go in for ultrasounds to monitor the pressure in the central cerebral artery. The fetus is at risk for severe anemia, swelling, and death. They can do blood transfusions inutero, but those are very risky. After birth, the baby may have to have repeated blood transfusions, and is at risk of kernicterus, a horrible neurological condition. Pregnancy, delivery, and birth become highly medicalized once you are sensitized. I feel like this is not something to mess around with, honestly. Our bodies are assaulted by "toxins" at every turn, and any "toxins" in this shot are probably far less damaging than having your baby's blood attacked and killed by your blood while he or she is still in the womb.

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#25 of 26 Old 01-01-2011, 03:06 PM
 
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Serenity, I just wanted to post and say that it's unfortunate that you have to go through a sensitized pregnancy. ((HUGS)). That said, with current care provided by peris and MFM teams, success rates are very high. I've been through two iso pregnancies without any issues whatsoever besides jaundiced babies that required double bilis and a week of hospitalization, but no further care required, no postnatal transfusions, nothing. And no after effects from the jaundice either. I've also been on a support group for years and out of the hundreds of iso moms on there, with antibodies from D to Kell (which is trickiest to monitor) to others, we've only had two losses in all that time...And yes, any losses are tragic and heartbreaking, but I also think of the amazing successes of some of our moms...ones with titers in the thousands, who undergo 8 or 9 IUTs, and who still manage to come home with babies at the end of it all. Many of us are cases of rhogam/winrho failure, so I almost feel like science eventually redeemed itself when it failed us to begin with.
 
Rhogam is a personal choice. Even after having had two senstitized pregancies, if I had to do it all again, I personally would not get a prenatal shot, but wait for the postnatal one. That's just my perspective. Even as the wife of a homozygous D hubby.
 
If you would like the link to the BG group, PM me. There's a great community of iso moms, many of whom have had multiple iso pgs, who provide much needed support and advice...they can make going through an iso pg a lot less frightening.
 
P.S. And if your hubby is heterozygous, you can determine the baby's blood type by cordo or PUBS (from about 19w on). Other moms on the forum have had it done. All peris are generally very skilled at the procedure as they only deal with high risk conditions. That way, if baby is negative, the stress is off and also you don't need to be under peri care for the rest of the pregnancy. And, as a bonus, it frees up the peris' time for us unlucky homozygous couples who have to tough it out until the end.

Mother to DD#1  s/b @40w 2003 for unknown reasons; DD#2   9.5 years old; DS  6 years old 
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#26 of 26 Old 01-05-2011, 10:41 AM
 
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I am O- and chose not to get the shot prenatally after all the research I did (apparently there were cases of bloodbourne disease transmitted via the shot in the 80s I believe, and it says it is not tested prenatally, and the stats say that the difference is so minimal I didn't want to risk the prenatal shot for those reasons). I was somewhat undecided as to whether or not I'd get the shot after baby was born if she was positive, but luckily I didn't have to decide as she was A- (DH's father is neg, though DH is pos he must be heterozygous). Barring traumatic incident I will make the same choice next time!

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