Rhogam & new Test - Mothering Forums

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#1 of 11 Old 09-11-2013, 07:10 PM - Thread Starter
 
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Posting here b/c I need diverse informed opinions.

So this is likely my last pregnancy. (This is relevant because sensitization only mostly affects subsequent pregnancies). However I am NFP 4eva, so you never know.

I have received Rhogam 5 times in the past. It is a blood product, which bears some degree of inherent risk (like all blood products).

My husband is positive. My first son is positive BUT my second son is negative, which means DH is Heterozygous (his blood is actually +- where mine is --). This means I only have a 50% chance of this baby being +.

Soooooo: now there is a test, from maternal blood, that can tell me the baby's blood type. Meaning I could potentially avoid a potentially redundant blood product exposure.

My options:
1. Decline the 28 week shot. (Which only reduces risk of sensitization from 1% to 0.1% if I accept a shot after delivery IF the baby is +. Rhogam after the birth of a positive baby reduces the risk of sensitization from 13% to 1%)

I found a Cochrane review that doesn't seem to support 28 week admin but I could be misinterpreting: it is standard practice here.

2. Accept the 28 week shot & just don't think about it.

3. Pay $300 OOP for a test to see if the shot @ 28 weeks is even indicated. (I am currently trying to get insurance to cover but it will most likely be a fool's errand).

I am soooo frustrated that a test exists that could help me & insurance doesn't cover it! (There was some cost/benefit done & they decided it is way cheaper just to give all negative women Rhogam).

Interested in y'all's thoughts. The theoretical risk listed on the pkg insert is BSE (mad cow). It might be relevant to know that altho all the meat in my home is local & grass fed, I ate two Wendy's burgers today, so I might have BSE already. wink1.gif
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#2 of 11 Old 09-11-2013, 07:18 PM - Thread Starter
 
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ETA: Cochrane Link: http://www.ncbi.nlm.nih.gov/m/pubmed/23450526/?i=4&from=rhogam
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#3 of 11 Old 09-11-2013, 08:24 PM
 
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I have never received the 28 week shot, not in four pregnancies. Have you had amniocentesis, or do you have any reason the believe your blood has or will mix? IMO, the 28 wk shot is not necessary outside of certain circumstances where blood mixes, and then it is easily administered at the time.

For the shot after birth, I have received it 3/4 times. My last birth, I didn't, and unfortunately it was a complicated homebirth with a partial placental abruption. I lost a lot of blood and did not feel like going into the hospital to get the shot. So I didn't. Of course if I was sensitized it wouldn't hurt me or my newborn, but rather future pregnancies.

4 years later we decide we want to TTC again. I was really worried about conceiving not knowing my status, so I got a cheap blood test, indirect coombs. It was fine.

We conceived and all is well. This is our last baby and I will not get the shot unless I have a transfer with birth trauma. And only then because while this is our last, you never know.

Getting the post birth shot is something you choose to do after the birth. Or, if you are planning an intervention heavy birth (for whatever reason, necessity, etc), you might just opt for it.
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Hi, I'm Tabitha. I'm a homeschooling mother of four: ds (11) dd (9) ds (7) ds (5) And I'm expecting a fifth in 2014! Find me at http://www.omelay.blogspot.com
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#4 of 11 Old 09-17-2013, 11:08 AM
 
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This is interesting. Dina, is the test for fetal blood type the same as the cell-free DNA test that checks for the trisomies? 

 

If so, that's a lot of bang for your buck, so to speak. It may very well be worth it to pay OOP for it. 

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#5 of 11 Old 09-17-2013, 11:18 AM - Thread Starter
 
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No, unfortunately they are done by the same lab (Senequenom) but are two different tests. ARUP also does the RhD. I suspect they may be less expensive, but having an issue getting the price from ARUP & now my insurance *says* they cover that CPT code . . .

I did have the Verifi test done (like MaterniT21) because of some heart drama we suspected, (I just couldn't take more inconclusive results) but it came back showing no anomalies. I asked if they could just use that sample but apparently they are processed differently.

The Verifi will cost me like $400, after insurance. It satisfied my deductible tho. So if this could be insurance billable, it would be no thing, as it would just be $ I would otherwise spend on the birth.
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#6 of 11 Old 09-17-2013, 11:20 AM - Thread Starter
 
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This pregnancy is off the hook expensive already: I have had a basic U/S, a MFM U/S & an Echo that have yet to be billed. I have to pay 20% until I hit 2000, but I am pretty much guaranteed to hit that just having the baby in hospital.
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#7 of 11 Old 09-17-2013, 11:31 AM
 
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Mm, that stinks.

 

The Cochrane review seems to be saying that the ante-natal shot is better than no shot at all, but doesn't directly compare it to a peri-natal shot, unfortunately. So, it's hard to know whether they're equivalent.

 

This is how I'd play it:

 

1.) Try to find a study that directly compares the 28-week Rhogam with Rhogam at birth (when the baby's blood type can be known). If they're equivalent, I would then wait to know the blood type. 

2.) If I couldn't find such a study, I would think long and hard about the risks of the shot versus the risks of possible future sensitization to a possible future pregnancy. 

 

ETA: 2b: Such pondering would include me meditating on how much I am willing to spend!

 

I personally am more comfortable with pharmaceuticals than you are, and under situation #2, if I couldn't afford the pre-natal blood test, would probably find more comfort in going with the 28-week shot than in forgoing it (though in my case this is all academic; I'm Rh positive). HOWEVER, I can see it the other way too, especially since you are planning on this being your last pregnancy. I'm afraid in lieu of a good study it really does come down to your personal comfort level (and personal finances), and that's not something that the internet can really help with, yanno? 

 

I mean, if not having an unnecessary shot is worth $300 to you . . .then pay the money! But $300 to me is different than $300 to you, so I can't really help with that decision . . . 

 

Good luck!

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#8 of 11 Old 09-22-2013, 07:58 AM - Thread Starter
 
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Update: Since I found another lab doing the test besides Senequenom, I figured they would be cheaper. And they were: slightly. 200 appx. Sooooo I finally called my OB back & they were now ready to order it!

So, test was done Friday. Results are in 2-7 days, but I have no idea when I will hear them. I suspect @ least by Thursday, I will be 29 weeks then. If the baby is +, I probably will go ahead & get the antibody screen & the Rhogam. Even tho it is supposedly my last pregnancy & even tho the prenatal dose only reduces isoimmunizon risk, & even tho any future baby only has a 50% chance of being +, I really hate to close my fertility door, even a little.
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#9 of 11 Old 09-24-2013, 08:09 AM
 
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I am also RH- 

 

I have never got the 28 week shot, *except* for my last pregnancy at 20 weeks because I had an amnio. It was triplets and one baby required two 'sticks' so it was four total. I did it then. 

 

After my 5th child was born, I was in the throes of a dark and horrible post-birth trauma and denied postpartum rhogam because I was absolutely positive I would never have another baby. Five babies later, I strongly regret that choice. Thankfully I never sensitized (she is B+, all my children are) but it was still a silly risk to take. Even though DH will be getting 'snipped' during this pregnancy, I will still get postpartum rhogam after the birth. You just never, ever know. 

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#10 of 11 Old 10-02-2013, 06:28 PM - Thread Starter
 
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Update! Great news! Baby is Rh-!

I was getting really worried because we are 2 days away from 30 weeks, but it turns out: no issue (at least 98%+ accurately no issue).
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#11 of 11 Old 10-08-2013, 02:01 PM
 
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That is great news for you!  What a relief!

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