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Hi everyone,

I've been searching online for awhile and can't find an answer - I'm hoping someone might be able to provide some insight on post-delivery Rhogam. I have Rh negative blood and did the Sensigene blood test, so I now know my baby is Rh positive. I skipped the 28 week Rhogam shot and did another antibody screen at 34 weeks (still negative so not currently sensitized). I would like to stay in this nonsensitized state but also would love to avoid Rhogam if it's a possibility; the pooled blood of tons of people injected into me makes me uneasy. I know if I don't get the post-delivery Rhogam, I have a 10-15% chance of becoming sensitized for subsequent pregnancies.

My question is: what role does the Rosette screen/blood test (or sheep's Rosette) play in the risk analysis? It's a blood test that can be done after the birth, with a fast turn around time, giving a negative or positive result. My understanding is that a negative result means the maternal and fetal blood did not mix; a positive result necessitates further testing (Kleihauer-Betke test) to determine the amount of blood mixing and thus amount of Rhogam to administer (standard dose may not be enough). Everything I've read says that if the Rosette screen is negative, the standard of care is to give the standard 300 mg dose of Rhogam. But why, if the Rosette is negative - meaning the blood did not mix? Is it just an EXTRA precaution? Or is there some scientific reason? I also read Rosette is 97% accurate (sorry, can't find source) while the KB test is more subjective. If the Rosette test were positive, I would definitely get Rhogam within the 3 day window (as soon as possible), but I am failing to see the need for Rhogam with a negative Rosette test. Thanks for any insight you can offer!
 
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