tell me about rhogam - Mothering Forums

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Old 07-09-2006, 11:49 PM - Thread Starter
 
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i got it with DS, because i "had to" ... what happens if you don't get it? what are its negative effects? TIA.

K,
mama to 4 boys - J (2005), A (2006), N (2008), and Z (2014)
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Old 07-10-2006, 12:14 AM
 
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I agonized over this for like months. What it came down to was:

1. I was not crazy about getting a human blood product, regardless of how "small" the risks of virus transmittance are. Judging from the government's definition of "small risks" regarding vaccines I don't put a lot of faith into the CDC.

2. I felt extremely uncomfortable putting anything into my body during pregnancy, given the possible future "unknown" problems that can result for a negative girl when she decides to have children. And the fact that there are some nasty chemicals in there. AND the fact that there have never been any studies done on the possible risks to the fetus, as Rhogam is a Class C drug: http://www.safefetus.com/DrugDetail....TradeI d=4936

(When I brought this up to my doctor, he said "There are no risks- no one has ever reported any fetal problems as a result of Rhogam" to which I replied "But there have never been ANY studies done on this" to which he replied "Well how could there be?")

3. I believe it to be pretty unlikely that mom and baby's blood mixes in the course of a normal pregnancy free of trauma or intervention.

4. I read a fantastic book (and really the only one out there) by Sara Wickham called "Anti-D in Midwifery" It is extremely scientific, gives tons of info on the actual studies done to support Rhogam (they are pathetic, few and far between, and don't even follow the scientific method). I told myself I wouldn't make a final decision until I read this book (and I am glad I did).

http://www.amazon.com/gp/product/075...Fencoding=UTF8

So I declined the antenatal dose, and got a load of crap from the doctor (I have since switched). He said I was the only person in 12 years to decline, and that I was being ridiculous and foolish. When I started feeding him statistics, he laughed and told me I can't believe everything I read, and that those numbers seem "a bit off." That is when I pulled out the package insert:

http://www.orthoclinical.com/Product...1-20-971-3.pdf

where I got my info from and flung it in his face. He certainly shut up then!

What I gleaned from the insert was that without ANY rhogam, your risks of becoming sensitized are 12-13%. With ONLY the post-labor injection, your risks go down to 1-2%. With both antenatal AND post-labor, your risks are .1-.2%.

I plan to have my baby typed after she is born, and if she is positive, then I will go ahead and get the Rhogam. In my mind, at least I am doing it because I actually know shes positive, I am only putting myself at risk, and I am taking it with the knowledge that I might actually need it because the stats for blood mixing in labor are much more real than during pregnancy. Basically I am taking a 1-2% risk.

Also, I think it is important to note that I have fully come to the understanding in my own mind that if I do become sensitized, then that is a consequence of my actions, and I still will not regret my decision. I don't feel that I can regret a decision of not potentially putting my beloved baby #1 at risk to save any future babies I might have. Other women who desire to have large families might feel differently, and that is okay too. Anyway, I hope this helps someone who may be really on the fence. I find that doing my research from government documents that SUPPORT the drugs actually aid in my decision making process (ironic as that may be).

Here are some links to previous discussions:
http://www.mothering.com/discussions...=455838&page=2
http://www.mothering.com/discussions...=258070&page=2
http://www.mothering.com/discussions...d.php?t=288233

HTH!
Amy

Amy, mommy to Ava, 6, Gavin, 4, Lila, 2, and Baby #4 due in early November! joy.gif
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Old 07-10-2006, 12:21 AM
 
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http://www.ctfphc.org/Full_Text/Ch11full.htm

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Old 07-10-2006, 01:40 AM
 
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If you do not get it, you may be sensitized, but it is not the end of the world like many docs make it out to be. Having come through a sensitized pg with a healthy baby, it can turn out OK, even though the pg adds a higher degree of stress.

I was given 4 shots of WinRho (Canadian version of RhoGam) during my first pg and was sensitized anyway. I have met many more moms online who were likewise sensitized after Rhogam shots, so I suspect the failure rate is a lot higher than the pharm company will admit.

Of all the sensitized moms I've met online, all have had come through their pgs OK and have eventually taken home their kiddos. That does not mean there was not a lot of testing, monitoring and interventions by the peris and MFM docs to ensure a good outcome but it is possible. Several have gone through 2 iso pgs. We are planning on going through another iso pg if we are lucky enough to be blessed with another child.

What was my iso pg like? They are all different...every mom's experience is different and even every fetus reacts differently to the antibodies, but here's my experience. Discovered I was positive for anti-D in the first tri. Docs assumed it was a false positive but sent me to consult with the perinatalogist anyway. Titers went up slowly by trimester. 1:1 in first tri, 1:2 in second, 1:8 in third tri...docs don't tend to think you require much attention until titers get over 1:8 or 1:16, but I've met moms online who have gone through iso pgs at 1:64, 1:128 etc. I had my titers drawn every 2 weeks (and after they went to 1:8 then every week but the doc thought that was unnecessary, it was just done to calm my nerves--if they were going up, then I'd want to know). I had BPPs and MCA dopplers every 2 weeks in the 3rd tri until delivery. I was induced at 37 weeks (better out than in usually and baby was considered full term) and she had pathological jaundice set in within 24 hours. She was put under the bili lights for a week and was well enough for us to take her home after that. We were lucky not to need transfusions (intrauterine or otherwise) this time but that's always a possibility.

I was reading MT's link...

Quote:
Once isoimmunization has occurred, the severity of fetal hemolysis varies. In 50% of the cases the fetus is very mildly affected and does not require postpartum treatment. However, without treatment, 25-30% of these offspring will have some degree of hemolytic anemia and hyperbilirubinemia, another 20-25% will be hydropic and many will die either in utero or during the neonatal period.
Again, doom and gloom. Emphasis I guess is "without treatment." Most iso pgs would be detected early on through routine early pg bloodwork. Mine was, as were many of the pgs of the suprised moms on my BG who had their rhogam shots and still developed antibodies.

Just a nitpicky thing...

Quote:
Obstetric history, maternal antibody titers and ultrasound are currently used to determine the need for more invasive tests during isoimmunized pregnancies, but in the absence of hydrops none of these reliably distinguishes mild from severe hemolytic disease.<6>
I don't agree with this. From my experience and the other iso ladies online, the MCA doppler scans (u/s scans on the mid cerebral artery of the fetus' brain to evaluate the baby's hemolytic status) can be very reliable and if done correctly, can provide a good week to week indication of what is going on. You'd think from this comment that all iso moms were subjected to weekly amnios to check their babies' status. In my experience (and from what the other moms have said as well) amnios are only used if the MCA doppler readings come back indicating moderate to severe anemia, then the amnio is used to correlate this. You can distinguish mild from severe hemolytic disease with non-invasive tests, otherwise all iso moms would be getting amnios and MCA doppler tests would not be performed at all...Docs prefer to use the MCA doppler tests first and only do amnios if necessary to reduce the risk to mom and baby and reduce the risk of resensitization.

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Old 07-10-2006, 11:16 AM
 
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I am subbing, as I am hoping to be TTC soon, and I will be having my 4th c-section if I should be fortunate enough to get pregnant again. I had the rhogam with all of the other 3 kids, my youngest is the only one who was positive.

I read about this here and see a lot of talk about how in "natural births" and "healthy birth" things are generally ok, but I wonder how my c-sections change things.

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Old 07-10-2006, 11:34 AM
 
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And, I believe the RhoGam is only to protect your next child, so if you (general you) aren't planning on getting pregnant again there's no point in getting it. Also, and correct me if I'm wrong here, if the baby's blood type is negative there's no reason to get the shot, either, so for my next pregnancy I plan on waiting until AFTER the baby's born and getting the shot IF the blood type is positive instead of exposing myself during pregnancy to a shot I may very well not even need.

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Old 07-10-2006, 11:57 AM
 
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Quote:
Originally Posted by Peppermint
but I wonder how my c-sections change things.
from what I've read, previous c-sections shouldn't mean you need the pre-natal (28 week) shot with subsequent pregnancies. I would assume that they type the baby after the section and give you rhogam if the baby is rh+. If you were to skip the post-natal rhogam shot after a c-section and the baby was rh+, then the fact that you had a c-section would increase your chances of sensitization.

Amy's post was right on and I used the same stats when I skipped the 28-week shot with my second child. My doc was flabbergasted but I held firm and promised that if I suffered any trauma prior to delivery, I would come in and get the shot. I am quite convinced that the rhogam shot had a negative impact on my first child which almost resulted in a blood transfusion (she is rh+ and I got the pre-natal shot).

If you look at the literature, you'll see that the studies on pre-natal rhogam are weak -- some countries give pre-natal shots at 28 weeks, others at 34 weeks, and others at both 28 and 34 weeks -- which is correct? And why does the post-natal shot need to be given within 72 hours of delivery? Because that's the window of time from the original study and had to do with when the doctors could get to the prison to administer the shot.

IMO, the pre-natal shot is a scam.
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Old 07-10-2006, 12:56 PM
 
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I had been wondering this for awhile, and since MT popped into this thread, I'll ask, in hopes she does again...

Is it possible to get a blood test BEFORE TTC #2 to see if there is sensitization? Or would it only show up after conception has occurred? I'm guessing that's not possible, since lots of Rh- women would probably want to do it before TTC.

I refused the 28 week shot, but did get it after ds was born (and he is +).

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Old 07-10-2006, 07:08 PM
 
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I don't see why you couldn't get a titer done even if TTCing. I just saw my OB last month and asked him for a titer to see what my levels are now (I ended my last pg at 1:8, want to see how much they went up after delivery...but aside from that titers are less reliable in a 2nd iso pg).

My sensitization for my first iso pg turned up early in my initial prenatal b/w. So, even if you did not get the test now, they could catch it early enough into the next pg to ensure you got referred to a peri.

J

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Old 07-10-2006, 07:25 PM
 
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I agree Japonica that the information is mostly scare mongering, and I don't think even that data is correct. There must be a lot of women who are sensitised who never go to a doctor and wouldn't know at the end that their babies had problems. They only usually get to see the babies who are in trouble, not the ones who come out normally.

I think the whole thing is a beat up. As insider once said.

Have it after the birth if the baby is a different Rh ... and if that doesn't "work" then what will anyway?

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Old 07-10-2006, 07:30 PM
 
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japonica, I have a friend that is sensitized (I don't know her levels are or anything) and she is pregnant again and is very worried about it. Do you have any good links for her? Is there a group somewhere she could join about this? She really needs to read some possitive outcomes instead of all the negatives she has been reading. Thanks!
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Old 07-10-2006, 08:27 PM
 
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Hi again,

What a great friend you are to seek out some support for her. Kudos. There are probably lots of med type web pages I could post but like you said, she's probably read enough of those and needs to hear from other moms who have gone through iso pgs (and all those frequent tests) and have come through OK and with a healthy baby.

There is an online support group for iso moms on Baby Center.

http://boards.babycenter.com/n/pfx/f...ebtag=bcus6675

Tell her to look at any threads with "iso moms" or "iso pg" in the title.

Here's their most recent thread (well, recent...it was started a while back and they keep it going). I think it's up to 45 pages long now...

http://boards.babycenter.com/n/pfx/f...ebtag=bcus6675

There's a lot of iso moms on there--even different antibodies: D, e, Kell..., some ladies have delivered already (and babies did very well, some needed initial care afterwards but that's always a possibility with iso stuff), many of the moms are going through the same tests and procedures. It just helps a lot to have the emotional support of other moms going through the same thing.

J

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