Originally Posted by trini
Can I jump on this thread and ask a related question?
Is it necessary to do it during the pg AND at delivery? Would it be effective to just do it at delivery, therefore preventing it from affecting the baby in any way?
Originally Posted by Momtezuma Tuatara
Hmmm maybe I should rewrite that?
|As an rh- woman myself who is only able to have rh+ babies dur to my dh being heterozygous positive|
Originally Posted by Momtezuma Tuatara
But your baby will not be damaged unless there is an event which will cause a second bleed. You are essentially in the same position as a person who has just had the shot.
You have antibodies which if you bleed again, could affect your babies, so you are actually in the identical position as a woman who has received rhogam. A woman who is given rhogam during pregnancy also has antibodies which, if she has a bleed and blood mixes will likewise damage her baby.
I don't understand why people don't see that.
It's basic, clear medicine.
The very argument you give here, shows WHY a woman shouldn't have rhogam during pregnancy.
|The rh+ cells of the baby stimulate rhogam production by the rh-mother's immune system. We want to prevent rhogam from circulating in the mother while she is pregnant because those antibodies will harm the baby. To do this we give rhogam immediately after birth so that any rh+ cells that are still in the mother will be destroyed. This keeps the mother's immune system from seeing those cells and producing her own rhogam which would stay in her circulation where they could attack any subsequent rh+ babies. Doctors would like us to inject rhogam antibodies during pregnancy to prevent the formation of rhogam antibodies. The rhogam will destroy all the rh+ cells thus preventing the mother from making her own rhogam antibodies. But what's the point, you prevented the mother's antibodies from being there by putting someone else's antibodies in the exact same spot. This is the point which I am not getting across: rhogam is the immune response to the baby. It is the pooled serum from rh- mother's who have had an immune response to their rh+ babies. You do not want those antibodies to come into contact with your rh+ baby.
Rhogam works. It works well. It should be administered after pregnancy like it is in Europe. During pregnancy is a decision that was made by the manufacturer to make money.
If a woman has a miscarriage she should have the shot immediately. If there is an amniocentesis performed it may be worth while to have the injection but there is some risk to that. It makes no sense to give the injection at 28 weeks during a healthy pregnancy. The blood does not mix in a sufficient manner to cause an immune response in the mother. If there were that much mixing then the injected antibodies (rhogam) would have access to the baby and kill the baby's red blood cells. It's a no win situation with rhogam at 28 weeks. The reason the manufacturer can get away with it is exactly because there is usually no blood mixing. The rhogam works it's way out of the mother's system without ever doing anything.
Another way to look at rhogam. Rhogam kills the baby's red blood cells no matter where those cells are. If the baby's blood cells are in the mother, those cells will be destroyed. If the baby's red blood cells are circulating through the baby delivering oxygen to the baby's brain, the rhogam will still kill those cells and deprive the baby of oxygen. It is not a good idea to take any chance that would allow the rhogam access to the baby. The doctors are concerned only about baby's cells circulating in the mother but antibodies diffuse much more easily than whole cells so the rhogam will readily find the baby's cells where the baby is than for the whole cells of the baby to find their way to the rhogam.
The makers of rhogam have funded some lame studies to show that getting the injection DURING pregnancy is more effective. I have found that most doctors are not intelligent enough to see the paradox becasue they blindly accept FDA and CDC recommendations. But there is a wonderful study that compared the efficacy of the post-natal vs. the ante-natal shot. The study examined the corporate studies and explained how they are flawed. It turns out there is absolutely no evidence to show that ante-natal is more effective than post-natal. So mothers should only get the shot post-natal IF the baby is rh+ (and the mother is rh-).
Here is a link to that study http://www.upstate.edu/fmed/cebp/Pre...ompilation.pdf You have to go to page 226
Page 234 summary on Th issues states
Fact. Rhogam antibodies cross the placenta and attack the baby's red blood cells (if the baby is rh+)? Well again it's just obvious but take a look at the package insert. Here's a quote from rhogam: ""Some babies born of women given Rho(D) immune globulin (human) antepartum have weakly positive direct antiglobulin (Coombs) tests at birth."" There's your admission by the company. Weak or not the test proves the presence of the antibodies in baby's whose mother received the shot while pregnant. One antibody molecule can wipe out one red blood cell - that's all it takes. Any amount of antibodies is dangerous because it decreases the baby's red blood cells and hence the oxygen that the baby's brain receives.
|Fact. Rhogam antibodies cross the placenta and attack the baby's red blood cells|
I am curious what people used to do before any sort of Rhogam. Rh negative women are not exactly rare.
|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.|
|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.|
|Do think it will be necessary to do the shot early and then again during birth?|
|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.|