# rhogam help



## EENS (Jul 8, 2005)

Mods - please move if this is in the wrong place.

Can someone please explain the theory behind the rhogam shot to me or at least point me in the right direction.

I'm 22 weeks and due to get this thing in a few weeks. I've had the shot with all 3 of my previous pregnancies, never thinking to question it. Now, the red flags are really going off in my head regarding this shot. If I do consent to this shot, I will insist on the mercury free version, though I do understand that there are other dangers and concerns regarding this shot.

One more thing. Is the book "Anti-D in Midwifery" by Wickham worth the read to a completely non-scientific mind or would it be over my head?
Thanks so much!


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## japonica (May 26, 2005)

Hi there,

Well, start looking at the thread in my siggie for a start.

I guess the other question is how many more pregnancies you're planning...if you're getting near the end of your baby days, there is less reason to get it (the main goal of it is to prevent sensitization in future pregnancies).

The worst that can happen if you don't get it is that you get sensitized. I got it 3 times during my first pg and was sensitized anyway and now I'm on my second sensitized pregnancy. So, being isoimmunized does not mean the end of childbearing.


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## BensMom (May 4, 2002)

I got the mercury filled version when pregnant with DS and suspect it has a link to his autism. I declined the 28w shot with DD and did take the postpartum shot, since I was planning one more child. I am declining the 28w shot again and am not 100% sure on the PP one this time. This is my last child, but you know....I plan, god laughs and all that.


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## cdk (Jun 17, 2007)

If you look at the rhogam insert, there is a 0.5% difference in sensitization outcome between getting the shot at 28 weeks and postpartum and just postpartum. I refused at 28 weeks and will receive it after the baby is born if he is +.


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## mama_in_PA (Nov 30, 2007)

I had the exact same concerns as I am supposed to have RhoGam at my next appt as well. Check this link: http://www.vaccinetruth.org/rhogam.htm. I decided to not have it during my pregnancy and if I do end up with an Rh+ baby then I'll have the thimerosol-free vaccine AFTER baby comes.


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## EENS (Jul 8, 2005)

Quote:


Originally Posted by *japonica* 
Hi there,

Well, start looking at the thread in my siggie for a start.

I guess the other question is how many more pregnancies you're planning...if you're getting near the end of your baby days, there is less reason to get it (the main goal of it is to prevent sensitization in future pregnancies).

The worst that can happen if you don't get it is that you get sensitized. I got it 3 times during my first pg and was sensitized anyway and now I'm on my second sensitized pregnancy. So, being isoimmunized does not mean the end of childbearing.

Great link, thank you so much!


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## EENS (Jul 8, 2005)

Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?


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## EENS (Jul 8, 2005)

Quote:


Originally Posted by *mama_in_PA* 
I had the exact same concerns as I am supposed to have RhoGam at my next appt as well. Check this link: http://www.vaccinetruth.org/rhogam.htm. I decided to not have it during my pregnancy and if I do end up with an Rh+ baby then I'll have the thimerosol-free vaccine AFTER baby comes.

From my reading so far, looks like I may be coming to the same decision as you. Thank you for the link.


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## wannabe (Jul 4, 2005)

Quote:


Originally Posted by *EENS* 
Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?

It's a passive immunity thing - they specifically want to prevent you having an immune response. So the rhogam antibodies would have been cleared by you in a few weeks.

If you're sensitised the reaction just gets stronger with each exposure (ie, more antibodies more quickly)

If you got the shot after the birth, she'll be rh+, because they test before they give it. Early in this pregnancy they'll have tested your blood for rh antibodies so you'll know if you're sensitised or not.


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## japonica (May 26, 2005)

Quote:

Does anyone know how long rhogam stays in the mother's system? I had it after my last child's birth, which will be 3 years ago at the time this baby is born. Does it make sense to find out HER blood type (I can't remember offhand) or will the antibodies have cleared my system?

Quote:

So the rhogam antibodies would have been cleared by you in a few weeks.
Just wanted to say that's not necessarily the case. I had my last winrho shot in August (03), when I had my first baby. When I was pregnant again, my prenatal blood work in April (8 months later) came back positive for anti-D (1:1). I asked the GP and he said, "Oh, it's probably just a residual from your last winrho shot." But he sent me to a peri for a consult just in case.

The peri saw me in May, looked at the 1:1 titer and said the same thing...residual antibodies from the shot. Turns out it was not just the residual winrho...I was actually sensitized, but both doctors assumed the winrho could stay in my system for that long. So, it must be possible.


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## Peony (Nov 27, 2003)

I found the book "Anti-D" to be a fairly easy read. I am from a medical background though, I read it all while out for coffee one am. I did recently loan it to another mom who is from a non-medical background, and she enjoyed it as well.


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## MsBlack (Apr 10, 2007)

The Rhogam is given at 28wks, IF mom shows negative for antibodies at that time, to prevent sensitization between then and birth. It is believed that the Rhogam is good for about 12 weeks, but NO ONE REALLY KNOWS, and it probably varies from woman to woman.

Often, Rhogam is given to any rh- mom after birth, without blood testing the baby to be sure it is rh+ after birth. Just because you got rhogam does not mean they blood typed your baby after birth.

Sensitization CAN OCCUR, even in women who faithfully get the rhogam. Why this happens is not certain; it may be because too small a dose was given to overcome the amount of fetal blood in the maternal circulation; it could be that rhogam simply doesn't work for all women. What is in an injection of rhogam is a particular amount of antibodies; more or less can be given tho there is a 'standard dose' which is 'generally applied' to cover 'average fetal blood amt in maternal circulation'. Problem being that maybe YOUR baby let MORE than the average amt of it's blood into your circulation--then 'standard dose' would not be large enough to disable the rh factor before your immune system responds by making its own antibodies.

How and why rhogam works is not a certainty. It is generally believed that by injecting the antibodies (harvested from rh- people purposely exposed to rh+ blood), one or both of 2 things may be occurring: one is that those antibodies will destroy all rh+ fetal blood cells that got into maternal circulation, BEFORE the mother's immune system has time to respond to the presence of the rh factor from baby's blood. And/or, that the presence of these antibodies basically 'tricks' mom's immune system into believing that it already has responded to the presence of fetal rh factor--so that it won't respond.

Whatever docs are saying to mothers like some who posted here is PURELY CONJECTURE.

There are specific blood tests that can be conducted during pregnancy and after birth to determine IF there has been a fetal-maternal transfusion, and if so, then HOW MUCH rh+ fetal blood cells are in mom's system. Only by doing these tests can you know for certain if you even need the Rhogam, and if so, then what dose is actually appropriate.

Kleihauer-Betke test determines presence of rh+ fetal blood cells in maternal circulation

Rosette test (or 'Sheep's Rosette') determines amount of fetal cells present.

These tests are rarely done because a) families don't tend to know about them and b) rhogam is considered so 'safe' as to be 'harmless' to a woman who doesn't actually need it (if there has been no sensitization from her rh+ baby; if she turns out to be carrying an rh- baby anyway). They also don't do these tests because most women do not get sensitized anyway--rhogam for all is to cover the need of a small %. And the docs figure that standard dose is good enough for the majority who do need it.

But you still need to understand that rhogam cannot provide any guarantees that you will remain antibody-free, or remain antibody free forever. It does work for most women, however.

If you can find Anne Frye's Understanding Diagnostic Tests in the Childbearing Year, there is lots more info in there.


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## japonica (May 26, 2005)

Yup, sure seems to be a lot of uncertainty and conjecture re: rhogam...I think part of the issue is guesswork re: how this whole immune aspect works (oh, let's inject antibodies, hope for the best, it should work) and the other part of the equation is doctors who don't believe in rhogam failure (much in the same way they don't believe in vax failure). Up until my titers started rising in the second tri, I was continually told it was just a residual trace of the winrho tricking the bloodwork.

And I did have a Kleihauer-Betke test...I recall reading on the autopsy/pathology report that the ME noted a "significant feto:maternal hemorrhage" and mentioned twice in the report that this was "of note" with an Rh neg mother. But the three doctors I saw afterwards, none picked up on this. Sigh. And folks wonder why I endlessly question and double guess doctors.


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## Shanana (May 11, 2005)

I just started reading the Anti-D in Midwifery book the other day. I come from a scientific background (engineer), but I'm finding it to be a _little_ dense (maybe part of it is the language thing, too -- UK vs USA). It could also be because I'm chronically sleep-deprived







. Anyway, I still think it's a very worthy read, and am amazed by just how little I knew about this (I've received the shot at least 4 times in my life, and am horrified that no one informed me of the risks ... or that I was even receiving a blood product!). I would recommend the book.

Quote:


Originally Posted by *MsBlack* 
There are specific blood tests that can be conducted during pregnancy and after birth to determine IF there has been a fetal-maternal transfusion, and if so, then HOW MUCH rh+ fetal blood cells are in mom's system. Only by doing these tests can you know for certain if you even need the Rhogam, and if so, then what dose is actually appropriate.

I am going to be tested soon to make sure I'm not already sensitized. Assuming I'm not, based on discussions with my midwife, I think it's likely I will decline the prenatal injection, and get tested for the presence of fetal blood directly after the birth. If none is present, I will decline the post-partum injection as well. If some is present, I may have the shot. Still have to finish the book and decide for sure, though.


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## liseux (Jul 3, 2004)

I am also rh sensitized, I had too little rhogam after a huge bleed. I only did it pp, once baby's blood was typed. Now that I'm sensitized I know that my dh is heterozygous, we can only have rh+ kids.

"If you're sensitised the reaction just gets stronger with each exposure (ie, more antibodies more quickly)" wannabe

Actually, this is not always the case. My titer with my 1st sensitized pg was 1:32 and my second was 1:8--not considered a big deal around here. My first ISO baby had anemia and jaundice at birth & stayed on lights for 7 days, my 2nd went home with me.


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## guestmama9904 (Jul 6, 2002)

i am rh neg and recieved rhogham. i am wondering; is it harder to get pregnant after recieving it?


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## japonica (May 26, 2005)

Hi liseux *waving*

Quote:

Now that I'm sensitized I know that my dh is heterozygous, we can only have rh+ kids.
You mean homozygous, right? (Same as our situation). If your DH was heterozygous there would still be a chance every pg for a rh- baby.

Yeah, titers can go up and down (I wish mine would go down--LOL). I'm currently at 1:64 and going for my peri consult next week. With my first iso baby, my titers were only 1:8 by the end and she was still under the lights for a week. It's amazing to see so much variation with everyone's experience of this condition and even from pregnancy to pregnancy.

Arismama, I don't know offhand if it makes it more difficult to conceive. I imagine health care providers will say no, but maybe someone else has other stories to share.


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## hapersmion (Jan 5, 2007)

Quote:


Originally Posted by *arismama!* 
i am rh neg and recieved rhogham. i am wondering; is it harder to get pregnant after recieving it?

Anecdotally... My rh- mother has four children. I'm not entirely sure how many shots she had. She always told me I'd have to get a shot in pregnancy since I'm negative as well, so I assume she probably had both the doses, unless they tested at birth before giving the pp one.

I hope it doesn't make it harder to get pregnant, since I had two or three doses







- I don't know why it would, though.

I'm definitely going to be doing those tests next time.


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## damselfly41 (Sep 21, 2006)

Okay, I just read the thread in Japonica's siggy. I am - and dh is +. Can I still skip the 28 week shot? Sorry to butt in.


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## peachymomma (Jun 25, 2003)

I am Rh- and really like this web site.
http://www.unhinderedliving.com/rhogam.html

My problem is not worrying about the 28 week shot because I KNOW I will not take it unless certain situations arise....

But My problem is after the birth... I am a homebirther and it is hard to find someone willing to give you a shot after you had a baby at home!

Anyways I did not get the shot at ALL during my last pregnancy because it was my *LAST* pregnancy







:

Anyways I am 9 weeks now.. LOL
I did have my levels checked and I was not sensatised at all.. I attribute that to a patiend midwife and a good birth experience


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## liseux (Jul 3, 2004)

Hey Japonica!
I am wishing you the best this time!

Yes, I meant homozygous, totally. We can never have an rh- baby because his 2 alleles are both +'s.


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## Shanana (May 11, 2005)

Quote:


Originally Posted by *arismama!* 
i am rh neg and recieved rhogham. i am wondering; is it harder to get pregnant after recieving it?

More anecdotal evidence ... I received the shot twice before conceiving dd (one abortion, one loss). We conceived her on our first month of trying. I was charting.

I've received the shot twice more since then (once while pg with dd, once right after her birth). We conceived this baby on the second try. No charting, just going based on my knowledge of my body and when I thought I was fertile.

So no, not in my case!


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## japonica (May 26, 2005)

Thanks Liseux. I'm hoping for the best and just trying to make it as far as we can without IUTs this time. We didn't need any with our last DD, but then my titers were lower...on the positive side, I've read a few accounts now of moms with titers around 1:1024 and higher who only had 1 or 2 IUTs in the whole pg, so that gives me a bit of hope.

And with all the dopplers, we'll get to see the baby lots...sheesh.


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## guestmama9904 (Jul 6, 2002)

Quote:


Originally Posted by *Shanana* 
More anecdotal evidence ... I received the shot twice before conceiving dd (one abortion, one loss). We conceived her on our first month of trying. I was charting.

I've received the shot twice more since then (once while pg with dd, once right after her birth). We conceived this baby on the second try. No charting, just going based on my knowledge of my body and when I thought I was fertile.

So no, not in my case!

glad to hear it!


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## adamsfam07 (Sep 9, 2006)

I've had the rhogam shot with all 3 of my pregnancies, I had never heard of all the risks before and never really questioned the dr. I guess. Now that I've read the links and all the posts I don't want to get it while pregnant this time, I'm just wondering what do you tell your Dr. when they say it's time to get it and do they ever give you any guff for not getting it? I'm only 17wks along but my dr. was already talking about it on my last visit, so I was just curious when my appointed shot time comes what should I tell my Dr? That I'll just get it done after the baby is born?


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## Veronika01 (Apr 16, 2007)

I'm rh- and dh is rh+. Both of our kiddos are rh-. I've never had the rhogam shot. During each pg my blood is tested for antibodies and it's always been clear. After reading up on rhogam, I've decided to decline the shot if this baby is rh+, even though she might not be our last baby. The shot does not guarantee that you won't be sensitized and the risk of permanent damage to my immune system is just not one I'm willing to take.


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## liseux (Jul 3, 2004)

Japonica, I think you have a good shot at avoiding IUT's. Even when titers go up they might not affect the baby--seeing the baby often does add peace of mind, I know it can be weird to have an ISO pregnancy--especially here,









To adamsfam07, and others who are considering skipping prenatal rhogam: you could say that you prefer to type the new baby's blood before doing any rhogam (or not taking it). I believe in most of Europe that only pp rhogam is given, and the sensitization rate is still low. If the birth is pretty normal and not traumatic, not a big blood loss, skipping it wouldn't be that big of a deal. You can definitely still get sensitized with rhogam & you can definitely not get sensitized without it. Its just hard to say which one could happen.


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## Shanana (May 11, 2005)

Quote:


Originally Posted by *adamsfam07* 
I'm just wondering what do you tell your Dr. when they say it's time to get it and do they ever give you any guff for not getting it? I'm only 17wks along but my dr. was already talking about it on my last visit, so I was just curious when my appointed shot time comes what should I tell my Dr? That I'll just get it done after the baby is born?

Just say you've done some research, and you will be declining the pre-natal injection. How much "trouble" your Dr gives you really depends on the doc. If they do give you trouble, then you might want to think about changing! It's important to have a care provider who respects you







.


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## Kidzaplenty (Jun 17, 2006)

For my docs, the 28 wk shot was not optional. Although I did end up not getting it after my second, but that was because I skipped the appointment. It has nothing to do with my sensitivity, but only to "cover their butts" (direct wording from the nurse).

FTR, I am rh- and so is my husband, and I have no chance of having a rh+ baby. Still, I am "forced" to have the shot if I go to the OB. Both 28 wks and pp. That is one reason I UC.


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *japonica* 
Just wanted to say that's not necessarily the case. I had my last winrho shot in August (03), when I had my first baby. When I was pregnant again, my prenatal blood work in April (8 months later) came back positive for anti-D (1:1). I asked the GP and he said, "Oh, it's probably just a residual from your last winrho shot." But he sent me to a peri for a consult just in case.

The peri saw me in May, looked at the 1:1 titer and said the same thing...residual antibodies from the shot. Turns out it was not just the residual winrho...I was actually sensitized, but both doctors assumed the winrho could stay in my system for that long. *So, it must be possible.*

No, not really. The assumption is just made that RhoGAM completely precludes any sensitization. The natural lifespan of the antibodies is 12 weeks.


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## EENS (Jul 8, 2005)

Just want to say thanks for all the terrific information. I am slowly making my way through all of it. I want to make sure I understand everything concerning this issue.


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## japonica (May 26, 2005)

Quote:

No, not really. The assumption is just made that RhoGAM completely precludes any sensitization. The natural lifespan of the antibodies is 12 weeks.
Yup, good to know the two doctors I saw (including a peri) were totally out to lunch then. I'll just add that to my mental file of "what doctors don't know about modern pharmaceuticals and the immune system."


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *japonica* 
Yup, good to know the two doctors I saw (including a peri) were totally out to lunch then. I'll just add that to my mental file of "what doctors don't know about modern pharmaceuticals and the immune system."

No, I didn't mean to say they were out to lunch. It's jsut that in practice, you develop shorthand ways of thinking of things (necessarily sometimes, given time constraints). I suppose the antibodies in RhoGAM could have a longer lifespan, but why would they?


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## japonica (May 26, 2005)

No offense taken or anything. I have a healthy scepticism of most things doctors tell me anyways...I also put it down to the fact that they usually just don't READ...so they might have just assumed it was the winrho shot and not have actually looked on my chart to see that the last shot was 7-8 months ago...

For the good news...met with the peris for the first time this 2nd iso pg and everything looks fine so far. We did a baseline doppler and we're starting ou routine dopplers every 2 weeks now...so far so good!


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## japonica (May 26, 2005)

bumping up


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## BlueEyedBabies (Jul 15, 2006)

I have a couple questions if any one knows.....

How long does it take for antibodies to show up in the mama's blood after birth if the pos/neg blood did cross at birth?

_IF it shows up quickly_ could you get a blood test to determine if you showed signs of the crossing,and if you were negative(no crossing accured) could you then decline the postpartum shot? Or if you did show signs of crossing then get the shot?

My sisters' midwife told her that she can get the shot up to 2 weeks postpartum and still be ok.Does anyone have info on that?
With one of my births,our ds was RH+,they took a blood test within a few hours after the birth and they said I showed no signs of crossing so they just gave me the mini shot of rhogam.All they said was since I had,had Rhogam before and that I was Neg. for antibodies that all I needed was the mini shot. Anyone have this happen before? It was at Contra Costa County Hospital in Concord CA.(if the shot only lasts 12 weeks I don't know why they told me _"since you've had Rhogam before_" unless they assumed I had the shot at 28weeks?)

I asked my Midwife about that with my next pregnancy and she knew nothing about doing it that way.So this thread got me thinking and I thought I might ask.

I am RH- and DH is RH+. Our first child was pos. I didn't know much about the whole Rhogam thing so I got the shot both at 28 weeks and after the birth. With our second,he was pos.I skipped the 28 week shot but got the "mini shot" I talked about earlier. Then with our third,she was pos. and I again skipped the 28 week shot but got the shot after birth.The next 2 I've had were both neg. so I had no shots at all with them.

Just wondering if there is a way to skip the shot if you have a negative blood test for the antibodies especially if you can go 2 weeks and then take a shot. I would assume anitbodies would show up before 2 weeks?

TIA!


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *BlueEyedBabies* 
I have a couple questions if any one knows.....

How long does it take for antibodies to show up in the mama's blood after birth if the pos/neg blood did cross at birth?

_IF it shows up quickly_ could you get a blood test to determine if you showed signs of the crossing,and if you were negative(no crossing accured) could you then decline the postpartum shot? Or if you did show signs of crossing then get the shot?

My sisters' midwife told her that she can get the shot up to 2 weeks postpartum and still be ok.Does anyone have info on that?
With one of my births,our ds was RH+,they took a blood test within a few hours after the birth and they said I showed no signs of crossing so they just gave me the mini shot of rhogam.All they said was since I had,had Rhogam before and that I was Neg. for antibodies that all I needed was the mini shot. Anyone have this happen before? It was at Contra Costa County Hospital in Concord CA.(if the shot only lasts 12 weeks I don't know why they told me _"since you've had Rhogam before_" unless they assumed I had the shot at 28weeks?)

I asked my Midwife about that with my next pregnancy and she knew nothing about doing it that way.So this thread got me thinking and I thought I might ask.

I am RH- and DH is RH+. Our first child was pos. I didn't know much about the whole Rhogam thing so I got the shot both at 28 weeks and after the birth. With our second,he was pos.I skipped the 28 week shot but got the "mini shot" I talked about earlier. Then with our third,she was pos. and I again skipped the 28 week shot but got the shot after birth.The next 2 I've had were both neg. so I had no shots at all with them.

Just wondering if there is a way to skip the shot if you have a negative blood test for the antibodies especially if you can go 2 weeks and then take a shot. I would assume anitbodies would show up before 2 weeks?

TIA!

Antibody response can actually take months in some women (it depends on how active your B cells are).

What the mother-baby studies screen for is preexisting isoimmunization: i.e., that you're already sensitized and RhoGam isn't indicated. Women who receive the 28 week dose will be weakly reactive at birth as a rule, so a titer below about 1:8 _at that time_ doesn't count as sensitized.

The mini-dose is NEVER recommended for routine postpartum prophylaxis. Each amount of RhoGam covers a certain number of cells. Unless they did a K-B to check the amount of fetal cells in your body (it's expensive and not often done unless there was an abruption and they're expecting mroe than the usual number of fetal RBCs), the full dose is given on the assumption that any feto-maternal bleed would be of sufficient size to require it. The mini-dose (which is only 50 mcg, as opposed to 300 for the full dose) is given for first-trimester losses or ABs because it's a theoretical risk anyway (the fetal blood suppply is so small it's unlikely enough RBCs would transfer to cause sensitization).

I've never heard of delaying RhoGam two weeks. Routine is 72 hours.


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## Kidzaplenty (Jun 17, 2006)

I always thought that once sensitivity has occurred, it has occurred. The shot is to prevent it from happening and once it does it is irreversible. So doing blood work to see if you are sensitive would not really do any good. If you need the shot, you will need it before you have developed sensitivity to prevent it or to keep it as low as possible.


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## maxmama (May 5, 2006)

Quote:


Originally Posted by *Kidzaplenty* 
I always thought that once sensitivity has occurred, it has occurred. The shot is to prevent it from happening and once it does it is irreversible. So doing blood work to see if you are sensitive would not really do any good. If you need the shot, you will need it before you have developed sensitivity to prevent it or to keep it as low as possible.

Right, which is why M-B studies are done. But RhoGam will give weak positive for 12 weeks afterwards.


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## BlueEyedBabies (Jul 15, 2006)

Quote:


Originally Posted by *Kidzaplenty* 
I always thought that once sensitivity has occurred, it has occurred. The shot is to prevent it from happening and once it does it is irreversible. So doing blood work to see if you are sensitive would not really do any good. If you need the shot, you will need it before you have developed sensitivity to prevent it or to keep it as low as possible.

Thanks,I guess I was just assuming







that once the blood crossed your body would immediately know and start to make the antibodies and you had 3 days to get the shot to "catch it". But I guess you have to get it _before_ your body ever knows.

Thanks for the responses! I'll have to ask my sister more about what her midwife was telling her about the Rhogam.Maybe she didn't understand correctly.


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## Song (Sep 13, 2007)

Hi, all. It's been very helpful to read through your posts. I am Rh negative and am struggling with when/if to get the Rhogam shot (1st pregnancy). Finding adequate, non-biased research has been a big challenge. Can someone recommend some good books or websites that would have some data to look at? Many, many thanks.


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