# RhoGAM?



## THBVsMommy (Mar 13, 2007)

Someone please point me in the right direction. I have a negative blood type and received 2 doses of this injection in my first pregnancy. Once at 28 weeks and the other after delivery.

I've began to research on it simply because it's a vaccine and I refuse them for my son, so of course I'm wary about having them done to myself. I wasn't educated on vaccines when I was pregnant with DS, but began after he was born and now we do not vax at all.

I'm finding some conflicting research on this particular vaccine that's really just leaving me between a rock and a hard place. Is it really nothing but beneficial, as I know there is a risk of Hemolytic disease if my baby has is Rh positive and our antibodies collide? Or am I putting him at just as much a risk of other serious complications in consenting to this vaccine?

I'm really just overwhelmed, so any information, links, advice you can offer is greatly appreciated. I've read of some mercury free brands of the shot and would be willing to pay the extra for those, but I still want more information before coming to any decisions. Thank you!


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## Medusa (Mar 25, 2004)

Well the first question is what is you husbands blood type. I know that's über- basic, but still strangly over looked by most OBs and CNMs.

If his blood type is also negative than it becomes a nonissue as all babies born to you as couple will also be Rh-.


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## stik (Dec 3, 2003)

Rhogam isn't a vaccine. It's a dose of antibodies. If you have artificial antibodies in your system, they will deal with any Rhesus factor that your system may encounter during a pregnancy without triggering an immune reaction that could kill any future children you may wish to have.

If your partner is RH- as well, there is no need for this, as your children will all be RH-, and won't produce any Rhesus factor for you to react against.

Hemolytic disease won't kill THIS baby (at least, not typically) - it will kill future ones.

You can get Rhogam without mercury.


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## japonica (May 26, 2005)

Quote:

Hemolytic disease won't kill THIS baby (at least, not typically) - it will kill future ones.
It will probably NOT kill future ones. I've had 2 successful sensitized pregnancies when my winrho shots failed. Yes, I was higher risk and sent to a peri for monitoring, but will careful care, most sensitized pregnancies ultimately result in healthy, living babies.

There are quite a few threads on rhogam in the Birth and Beyond forum.

Personally, I don't think a lot of it based on my experience. I was given three prenatal shots in my first pg. They failed anyway plus my first baby was stillborn for unknown reasons at term but the pathology and autopsy showed that some kind of immune reaction took place that cut off all blood flow in the placenta and from the IUGR rates it started after my last prenatal shot, which is an odd coincidence. Later I looked into how rhogam and winrho is made, from the pooled plasma of thousands of donors and the package insert event says that it may contain CJD or other unknown infectious agents. It's also a class C drug and has not been evaluated for safety on pregnant women.

Sensitization is not a great outcome but it's also NOT the end of the world either.


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## stik (Dec 3, 2003)

Japonica, I'm very sorry for your loss.

As you note, Rhogam doesn't always protect against sensitization. It's fantastic and amazing that you've had two successful pregnancies following sensitization. Your experience is highly atypical. RH sensitization causes serious problems including fetal organ damage and death in many cases. These complications have been rare since the use of Rhogam became routine.

In contrast, there are absolutely no recorded cases of any blood borne pathogens being transmitted through the Rhogam shot.


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## japonica (May 26, 2005)

Atypical? I belong to an online BG of sensitized women, everything from anti-D to the others that are not preventable through injection and with the hundreds of members we have, there have only been 2 losses, both times the babies were lost before they could receive transfusions. All of the other mothers have had satisfactory outcomes and healthy babies. The level of perinatal care these days for Rh issues is very high (having just been through it myself personally twice) so it has advanced tremendously even from 5 years ago. And there are many, many anti-D moms on there, so I suspect the failure rate is higher than what many believe it to be.

Whether or not the medical establishment reports any transmission of an infectious nature is not something I rely on. The manufacturer themselves report that they do not screen for everything. It is a blood product and other blood products in the past have led to infection. If there is an infectious agent present that 1) the manufacturer does not or cannot screen for at present and 2) standard lab tests do not or cannot detect currently, then what would there be to report? So, no reports doesn't mean a lot to me, especially when most doctors and scientists refuse to believe in or report adverse vaccine reactions and other permanent damage related to vaccines.


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## 13Sandals (Sep 22, 2006)

Stik wrote:

Quote:

_In contrast, there are absolutely no recorded cases of any blood borne pathogens being transmitted through the Rhogam shot._

No. This is completely untrue. A large number of women in Ireland received compensation when it was discovered that a batch of Rhogam (Anti-D) was contaminated with Hep C. At the time, they did not screen for this particular virus. Of course, they screen for it now, and any other KNOWN vriuses. Rhogam is a whole blood product, you can be certain there are undetectable levels of many viruses present as well as, as of yet, unidentified viruses. Of course there is a risk.

You should find out your hubby's blood type. If he's negative, there is no possible way to have a positive blood type baby - no shot. If he is positive, the system of pregnancy is designed to keep the mother and baby's blood separate. Therefore, in a perfect world, no sensitization would occur. If, (heaven forbid) you had a potentially sensitizing event (like accident, fall on the stomach, miscarriage, traumatic birth like a cesarean - anything that might cause the baby and mother's blood to intermix) - you could decide to get the shot in that case. This is what used to be recommended when the shot first came on the market. You have, theoretically, at least 48 hours after a sensitizing event (my midwife told me I had up to 7 days and would still be fine) to get the Rhogam - (which, as one poster said, is not a vaccine, but antibody shot).

Of course, you could have a small bleed, or sensitizing event without knowing it and risk an antibody response, but as was said, the danger to the current pregnancy would be next to nothing - not to say there would NEVER be a risk, but the odds are overwhelmingly in your favor. The antibody response takes a while to build.

I am a negative blood type and took Rhogam with my first (my hubby is positive), but refused the rhogam for my next two. I decided to have the baby's blood typed after the birth. I decided that if the baby was a positive blood type, I would review the birth and decide if I wanted the shot. However, my husband turned out to be heterozygous for the rhesus factor and my next two children were negative blood types!


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## amnesiac (Dec 28, 2001)

Since this is not vaccine-related I'm going to move it over to B&B where I think you will likely get more pertinent information.


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## stik (Dec 3, 2003)

13Sandals, I hadn't heard of the Irish cases. Do you have a source for those?

Japonica, I'm thrilled to hear that the new treatments for sensitization are so successful. That said, given a choice between:
a) a shot in the hip that almost always works, or
b) an intensely managed and monitored pregnancy with umbilical transfusions a high chance of medically necessary c-section, and a still higher than normal chance of serious complications and fetal death,

I'll take the shot in the hip.

I don't think option b is the end of the world if it all works out. But I do think I'd rather prevent it if I could.


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## tessie (Dec 6, 2006)

Quote:


Originally Posted by *stik* 
Japonica, I'm thrilled to hear that the new treatments for sensitization are so successful. That said, given a choice between:
a) a shot in the hip that almost always works, or
b) an intensely managed and monitored pregnancy with umbilical transfusions a high chance of medically necessary c-section, and a still higher than normal chance of serious complications and fetal death,

I'll take the shot in the hip.

I don't think option b is the end of the world if it all works out. But I do think I'd rather prevent it if I could.









:

The two losses mentioned by Japonica are just two too many for my liking.


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## japonica (May 26, 2005)

Stik, to each their own. I had all the shots, performed by doctors, in the doses recommended, and they still failed, and my child died for unknown reasons with a decline right after the last shot. Knowing what I do now, I would never get another prenatal shot but everyone's risk-benefit analysis on these things is different.

Yes and it is great that the perinatal care for sensitized mothers is so good so that when it does fail (and for some women it always will) and when the medical community that tells us it is foolproof is proven wrong that we still have the option of having healthy babies. Oh and I never had a single IUT, not one in 2 pregnancies, nor did I have any c-sections and both of my babies were born at term. If I were a few years younger, I'd definitely have one more child.

I am not recommending anyone either choose or forgo a rhogam shot. What I do take exception to is overgeneralizing how "bad" things are for sensitized pregnancies. Like I said, I have been through 2 now with NO complications. I am on a BG with hundreds of women who have had healthy babies (yes, some after IUTs and early inductions) but they were not at any higher mortality risk than a lot of other high risk mothers out there.

Any loss is tragic. But to automatically equate sensitization with a death sentence for a child is not accurate nor a true portrayal of the experiences of most of the women out there.

And Tessie, one of the losses was a mother with anti-M and anti-C contracted through previous blood transfusions. Anyone who has ever had a blood transfusion also has to watch for this. No rhogam would have prevented her child's death.


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## bluedaisy (Sep 5, 2008)

I spent MONTHS researching rhogam....eventually I decided to decline the 28 week shot, get my baby tested after birth, and then get the rhogam after delivery IF my baby was positive.

She was positive, so I got the shot after she was born.

These were my main reasons:

- There were NO safety studies done on rhogam's effect on the fetus. the only studies i could find were testing if giving the shot at 28 weeks was effective, NOT if it was safe

- rhogam is a blood product. it is impossible to screen for all viruses, known and unknown. the rhogam website even acknowledges that risk

- before the 1990s, it was standard procedure in the US to wait until the baby was born, test the baby, and then give Rhogam if positive. this got sensitization rates down to 1-2%. then they found out giving it at 28 weeks decreased the risk to less than 1%. Many countries still only give Rhogam after the baby is born. to me, a 1-2% risk was still a really low chance of being sensitized.

- every source acknowledged that mom's blood and baby's blood mixing in the womb was very rare. most blood mixing and therefore sensitization occurs at birth. I would have considered getting rhogam before birth if I had had a fall, accident, or bleeding or spotting, all of which can increase the risk of blood mixing before birth.

- I talked with homebirth and birth center midwives who do not routinely offer the 28 week shot but only the postpartum shot.

My hospital based midwives were NOT happy with this decision, and for four appointments straight they tried to scare me into getting it. after every appointment, i would do further research and gain more confidence in my decision.

finally i printed out all the research i had done and printed a letter with my main reasons for declining the 28 week shot and told them if they had more recent research that contradicts what i've found then i would be willing to reconsider.

all of my links are on my old comp - PM me if you want more info.

good luck!!


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## Delicateflower (Feb 1, 2009)

Quote:


Originally Posted by *tessie* 







:

The two losses mentioned by Japonica are just two too many for my liking.









:

Not to mention having so many ultrasounds and such a medically managed pregnancy.

I found this on the complication rate on transfusion in utero. Scary!

Quote:

What is intrauterine blood transfusion?: Intrauterine blood transfusion is a highly specialized procedure where a fetus, while still inside the uterus, is given a blood transfusion to treat severe anemia (low blood level). The goal of this procedure is to prevent stillbirth from anemia, and to prolong the pregnancy to a point where prematurity is no longer a significant risk.

How is intrauterine blood transfusion performed? Intrauterine blood transfusion is a highly complex procedure, generally performed only by a perinatologist. Ultrasound is used to visualize the umbilical cord and the point where it attaches to the placenta. A needle is then placed into the vein of the umbilical cord at this site, and, based on fetal size and blood count, a calculated volume of blood is transfused into the vein in order to restore the baby's blood level to normal.

Who is a candidate for intrauterine blood transfusion?: The most common reason an intrauterine blood transfusion is performed is when a fetus is severely anemic due to an incompatibility with maternal blood. *Because of the risks of the procedure, it is only performed at early gestational ages, when delivery is not an option because of the risks of prematurity*. It can also be performed for fetal anemia caused by certain viral infections. Usually, there will have been many other tests performed to evaluate these problems before the final decision for intrauterine blood transfusion is made.

What are the risks of the procedure?: Depending on the reason for the procedure and the condition of the fetus, there may be as much as a *5% to 7% chance of some type of complication during the procedure that would make immediate delivery via cesarean section necessary, or lead to loss of the fetus by still birth*. That is why this procedure is only performed if there is a high chance of losing the baby if the procedure is not done. Although these risks are fairly small, the procedure is performed in a labor and delivery unit so that immediate intervention can be instituted if a complication occurs.
http://www.communitymed.org/RMPA_Int...ne_Transfusion

I'm sorry, I'm very glad they can help these babies now, and it's not a death sentence, but for me and my baby losing the normal healthy pregnancy and birth and post-natal experience over the miniscule risk of a blood product is not worth it.


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## japonica (May 26, 2005)

I imagine it does sound scary when someone who has not gone through a sensitized pregnancy reads about it. Yet, for many of the iso moms, they do not see it in the same way. I know women on their 5th (yes, 5th) sensitized pregnancy, complete with the IUTs. You'd think this would be reason enough for them not to continue having children, but for a lot of them they see this as part of the risk. The majority of moms in the group have gone through multiple IUTs with no losses. The only losses were the ones who did not get the IUTs in time. And none of the women I met online were ones who became sensitized through declining rhogam/winrho. We were all sensitized anyway through product failure or physician negligence. There is often a lot of shock and anger when mothers find out they are positive. We had been told that the product almost always works and would keep our future pregnancies safe. Yet from the sizeable number of moms who keep joining us, either the product has a larger failure rate than advertised or physicians are not administering it properly and in the time window mandated.

There is also a sizeable number who have other antibodies besides D (the one in the rhogam shot) who were sensitized through blood transfusions during previous m/cs, deliveries etc. These are also problematic antibodies (some equally or more dangerous than D, like Kell for instance) and I urge anyone who has had a blood transfusion to make sure that they did not develop any of these antibodies.

As for ultrasounds, my children had about 10 each. I'd take those over losing them to HDN or getting multiple amnios every 2 weeks. And to date, neither has shown any ill effects. My daughter is 4 and a half and reading at a grade one level already. My son has reached his milestones on time. Both are extremely healthy.

Like I said, I am not advocating that people refuse rhogam but that they really consider all the issues and make the decision that works best for them. For some, that will be declining it completely (I know some moms on their last pg who have done this). Or only doing the shot postpartum IF the child is Rh positive. And for others, prenatal shots is something they feel most comfortable with. Everyone's analysis of the situation is different.


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## Delicateflower (Feb 1, 2009)

Quote:


Originally Posted by *japonica* 
Yet from the sizeable number of moms who keep joining us, either the product has a larger failure rate than advertised or physicians are not administering it properly and in the time window mandated.

But with the known failure rate of 1%, and 4 million births a year, 15% of whom are rh-, that's 6,000 new sensitisations a year. Do you have more than that join your list a year?

Quote:


Originally Posted by *japonica* 
I know women on their 5th (yes, 5th) sensitized pregnancy, complete with the IUTs. You'd think this would be reason enough for them not to continue having children, but for a lot of them they see this as part of the risk.

As for ultrasounds, my children had about 10 each. I'd take those over losing them to HDN or getting multiple amnios every 2 weeks.

This is a false analogy. The choice is not between a dead baby and lots of ultrasounds and IUT and prematurity, but between a rhogam shot and lots of ultrasounds and IUT and prematurity and a dead baby.


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## japonica (May 26, 2005)

Quote:


Originally Posted by *Delicateflower* 
But with the known failure rate of 1%, and 4 million births a year, 15% of whom are rh-, that's 6,000 new sensitisations a year. Do you have more than that join your list a year?

This is a false analogy. The choice is not between a dead baby and lots of ultrasounds and IUT and prematurity, but between a rhogam shot and lots of ultrasounds and IUT and prematurity and a dead baby.

Yes, well, that's if the rhogam shot works to prevent sensitization, which as you pointed out is not always the case. And it is also if refusal equals sensitization, which has also not been the experience of every mother. I do know of a few who have refused for various reasons and have not become sensitized. So, there's a few variables to add to your analysis.


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## Delicateflower (Feb 1, 2009)

Quote:


Originally Posted by *japonica* 
Yes, well, that's if the rhogam shot works to prevent sensitization, which as you pointed out is not always the case. And it is also if refusal equals sensitization, which has also not been the experience of every mother. I do know of a few who have refused for various reasons and have not become sensitized. So, there's a few variables to add to your analysis.

I would take 0.4% chance of being sensitised with rhogam over the 7% (1 in 15) chance of being sensitised without it.


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## bluedaisy (Sep 5, 2008)

Quote:

I would take 0.4% chance of being sensitised with rhogam over the 7% (1 in 15) chance of being sensitised without it.
there is a much smaller chance of getting sensitized if she only refuses the 28 week shot, and her risk is still less than 2%.

there hae been NO safety studies done on fetuses for giving rhogam at 28 weeks - that doesnt concern you?

drugs are being recalled all the time because there were side effects that they just didnt know about.

a developing fetus is so sensitive, and they really have no idea if rhogam affects the fetus or not.

there are NO drugs or vaccines that are 100% safe, every drug has its risks. it drives me crazy when people talk about the situation like sensitization is the only risk.

Honestly, the risk of sensitization is small, but it's a real risk. the risk of harming the fetus with rhogam is small, but it is also a real risk.


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## stik (Dec 3, 2003)

Bluedaisy, what negative impacts on fetuses do you think the 28 week shot may be causing? What data is your concern based on?

I don't think it's appropriate to compare the real, known risks of sensitization with the imagined, hypothetical risks of the 28 week shot.

(Though personally, I wouldn't opt for the 28 week shot unless something happened that made me think my personal risk of sensitization was high - like a car accident.)


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## bluedaisy (Sep 5, 2008)

Stik, you even said that you wouldnt get the 28 week shot - if you don't think there's a risk to it, why wouldnt you get it?

There are very real risks to the 28 week shot (I am only talking about the risks to the fetus in the 28 week shot, NOT the postpartum shot, which I did receive)

- The risk of a virus or other blood borne pathogen - from the official Rhogam website:

RhoGAM® and MICRhoGAM® Ultra-Filtered PLUS Rho(D) Immune Globulin (Human) are made from human plasma. Since all plasma-derived products are made from human blood, they may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD) agent.

We simply don't know the effects on the fetus of exposure to viruses or other blood borne pathogens.

- also from the rhogam insert, there is a risk that IgE antibodies are present in Rhogam.

IgE antibodies are the antibodies that a mother's body creates in subsequent pregnancies that attack the baby if the mother is sensitized.

If IgE antibodies in the mother's blood attack the positive baby, wouldn't IgE antibodies in Rhogam also attack the baby?

If I'm understanding correctly, that is why japonica beleives her baby was stillborn (i am so sorry for your loss).

When I was researching, I encountered several women whose babies were stillborn or born severely anemic, and they believed it was due to the Rhogam shot.

Someone mentioned that the two losses that the sensitized women had were two too many - i agree, but what about babies who were lost because of Rhogam? Those numbers are also small, but EQUALLY TRAGIC.

This is not a situation of a "harmless" shot in the hip vs a serious medical condition.

- Finally, rhogam used to contain mercury. In looking at the population of women with autistic children, rh negative women were disproportionately represented. pregnant women are told to limit fish intake because of mercury, and yet for years they injected mercury directly into the bloodstream of pregnant women.

I realize mercury is no longer in rhogam - however, there are other preservatives that we simply do not know how they will affect the fetus because there havent been safety studies done.

Most pregnant women are so careful with every little thing they consume or drugs they take while pregnant because they realize there is a risk that a foreign substance can harm their baby.

Finally, other thing I considered while I was pregnant was that taking Rhogam at 28 weeks put my baby at risk (regardless of how small that risk was, it was still a risk)

Not taking rhogam would put my future babies at risk (again, a small risk but still a risk - and a risk that I could minimize by taking the rhogam shot AFTER my baby was born)

In my mind, I had to protect the baby that I had at that moment. I hope to have 3-4 children, but there is no guarantee that I will ever have any more children.

So, it made sense to me to only get the shot after birth - that way, my baby was at NO RISK from rhogam, and I was still minimizing the risk of sensitization for future babies by getting the rhogam shot after birth.

Hope that helps, good luck in your decision, I spent months going back and forth as I was reading the research. But after weeks of fighting with my midwives over it and reading the research again and again, I am confident in my decision and will not be getting hte 28 week shot with any future pregnancies unless I have an accident or bleeding or something that makes me a high risk for sensitization.


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## stik (Dec 3, 2003)

Bluedaisy, I'm sorry for everyone's loss that has one. However, the plural of anecdote is not data, and a mother's belief is not the same as a scientifically supported conclusion.

Also, though I'm having trouble looking it up, I really don't think the total number of deaths caused by hemolytic disease in the US in the past few years is 2. That's the number on Japonica's other message board. Given the preventability of the condition, I think it's likely most common among women who have little or no access to prenatal care. This population is also not likely to have easy access to internet message boards.

I have now heard of ONE incident in which Rhogam transmitted a blood borne pathogen, and I haven't yet seen a citation to back it up. I'm reserving judgment until I do. In any case, there has CERTAINLY never been a case of CJD being transmitted by the shot. If you eat beef, you take on a risk of CJD that is infinitely greater than the demonstrated risk of the Rhogam shot.

There are IgE antibodies in Rhogam - that's what the shot is for. The idea behind the shot is that a limited dose will deal with the RH+ blood cells that enter the mother's body without triggering a natural reaction which would create a practically unlimited supply of antibodies. The limited numbers are supposed to limit the reaction.

Where are you finding that RH- women are disproportionately represented among mothers of autistic children? And what makes you think that correlation MUST be a result of the rhogam shot and not of some other factor that may be more common in RH- women?

I opted out of the 28 week shot because I opt out of any medication I think is likely unnecessary, whether I think it's harmless or not. But in cases of known or suspected bleeding, I think it's a good choice. And I think suggesting that the shot is uber-risky and will cause autism and CJD and stillbirth is, to be frank, a hysterical mis-representation of the facts.


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## littlecindy (Feb 14, 2008)

does anyone know if measuring small low birth weight could have anything to do with getting the shot at 28 weeks?


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## gini1313 (Jul 5, 2006)

Well, this is entirely anecdotal, but I had the shot with both my kids at 28 weeks and they were both over 9 lbs...

And, just FYI, there is a blood test they can do after birth to look for blood mixing. I don't know if it entirely eliminates the "need" for the postpartum shot or not, but they tested me after my uncomplicated, natural, intervention-free hospital birth (because my doctor is very thorough) and I had fetal blood mixing. They did another test that told them how much rhogam I needed (and I wound up needing 3 shots) to prevent sensitization and then tested 6 weeks later to be sure I had not become sensitized.

I do not know, but I would conjecture that if the test showed no blood mixing that the shot would be unnecessary? Maybe those who are concerned about the 28 week shot could request that test to see if there was any blood mixing?

Also, for those of you who do not get the 28 week shot due to risk of the fetus, are there not risks of taking a drug while breastfeeding?


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## bluedaisy (Sep 5, 2008)

I never said the shot was uber-risky, I said in my posts that the risks of getting the shot are very small, i was just trying to emphasize that it's not risk free.

my midwives couldnt understand why i didnt want it because in their mind it was risk free. but no medicine is completely risk free.

you asked me what the risks were, those were the possible risks I found in my research. i would prefer scientific data too but my point is there is NONE - they havent done any safety studies,

my info on rhogam and autism actually came from an old issue of MOthering - my doula has back issues from the 80s and 90s that i borrowed.

i printed out all my research in a folder but i gavve it to a pregnant friend who is also rh negative so i cant tell you the date of the issue.


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## Peppermint (Feb 12, 2003)

I am on my 5th pregnancy, I had the 28 week Rhogam with the first 4, and only needed the shot after birth once, the other 3 babies were all rh- like me.

This time I finally decided (after tons of research over years) that I would not have the 28 week shot, and would only have one during pregnancy if there was an accident or bleeding issue in that last (for me) 11 weeks of pregnancy. I will still use the shot after birth if this baby is positive, as I feel that is a "risk" well worth taking, unlike the 28 week shot.

AFAIK, the numbers of sensitization when using the 28 week shot and the after-birth shot are .8%, whereas without the 28 week shot, it is 1.8%, I am comfortable with that difference. My OB simply said "I kind of figured you would deny the 28 week Rhogam this time" and that was that. No argument at all, he knows I have done my research, and we talked last time about the fact that it is a human blood product and that they can only test for things we know about now, and it has preservatives, etc.

I really do feel like Rhogam is all around a positive medical advancement, it is just that (IMNSHO) we have taken it too far with the routine 28 week shot.


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## dinahx (Sep 17, 2005)

I don't understand why no one is taking Japonica's loss and her theorey about why it happened seriously! It is upsetting me a great deal. Of course unknown viruses could be transmitted!

Additionally, until very recently, mother's were dosing their unborn with Thimerisol to achieve a very small reduction in risk by getting the 28 week shot. Clearly the greatest reduction in risk comes from the shot after delivery of a positive baby.

I have had Rhogham many times, I think 5 in total, 2 in my pregnancy with my son. However, I can awknowledge there are RISKS, and I also tend to believe that a mother's analysis of why her baby died is typically right.


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## dinahx (Sep 17, 2005)

Additionally, mercury and neurological disorders being linked is hardly 'hysterical'! Google 'minamata disease'. Also, I consider eating beef to be safer than taking an injection of a blood product. Injection is not injestion, the liver and kidneys are excellent at filtering. Women being given mercury in pregnancy is a calamity, a travesty, a crime, really. Although of course they could also have gotten it from the Flu shot, Tuna Fish, or living near a coal plant.

The package insert of Rhogham lists the theoretical risk of CJD, FTR. Also, how would you know if it has been transmitted? CJD takes years to show up. Again, I've gotten Rhogham a lot in my life, but I can awknowledge that there are risks and that some risks may be not clearly understood and under-reported.


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## stik (Dec 3, 2003)

There is no mercury in Rhogam at this point. I checked the manufacturer's website. I absolutely agree that mercury is a dangerous neurotoxin, and while I'm skeptical about it causing autism, I don't think people should be injected with it. But there isn't any in Rhogam.

No one has yet produced a citation that says Rhogam causes Autism - all we have here is a vague memory of one in a magazine that, while respected in this forum, is hardly a scientific journal (and doesn't claim to be - it's a natural parenting magazine). The same mag has published claims that HIV does not cause AIDS, that estrogens in soy mess with children's hormones, and that marijuana is safe in pregnancy. I enjoy reading, but I take _Mothering's_ scientific claims with a huge grain of salt.

The day we figure out what causes autism will be a great day. IF RH- mothers are indeed disproportionately represented among mothers of autistic children, that may be an interesting clue. But even *if* that is the case, it doesn't necessarily implicate Rhogam. It could point to a gene that's more likely to be associated with RH- blood, or to a gene that is more easily expressed in the absence of RH factor, or to problems caused by as-yet-unknown complications of RH incompatibility. We would need to know so much more than just numbers of RH- moms of autistic children to work it out.

It feels disrespectful to me to argue about the cause of another mother's loss, which is why I've avoided it. Suffice it to say, I think a mother's instincts about the causes of her child's death are *sometimes* right. It would take a lot of investigation before I felt comfortable agreeing with anyone's statement on the cause of any death.

Every human blood product carries a theoretical risk of CJD (and I suspect their package inserts all note this risk). So does every slice of meat. So does the blood used in IUTs given to fetuses with hemolytic disease. According to the manufacturer's website, the plasma used in Rhogam comes from a select group of carefully screened donors, and is itself screened, filtered, and processed to prevent virus transmission. NO ONE has ever gotten CJD from Rhogam. The risk is a theoretical possibility.

On the other hand, while CJD continues to be a rare disease, most of its victims have gotten it from eating meat.

Untreated, HDN kills 25% of babies of sensitized moms, and causes serious problems in another 25%. This is an infant mortality rate 10 times higher than the US national average of 6.9/thousand for RH+ children of moms who are RH sensitized. That's higher than the risk of autism (currently estimated at 1 in 150.) It's higher than the risk of ever getting CJD from any source.

I think it makes sense to question the necessity of a 28-week shot for all RH- moms. I think it makes sense to ask what measures are being used to keep a human blood product safe, and what methods are being used to assess the effectiveness of those measures.

I get angry when I see treatments that save a lot of lives presented as if they are frightening and dangerous things, especially when that depiction is based on misrepresenting the treatment. Rhogam doesn't contain mercury. No one has ever gotten CJD from it.

Claims about CJD and stillbirth and mercury encourage people to make decisions based on fear of the imaginary rather than on logical consideration of the actual risks and benefits. That's why I called them a hysterical misrepresentation of the facts. Because if you're RH-, and your partner is RH+, and you're 30 weeks pregnant and you've been in a car accident, the world wide web should not be telling you that Rhogam is likely to cause autism, CJD, or death, when in fact it's most likely to prevent serious complications in future pregnancies.

Sometimes, I think we get so tangled up in considering every conceivable risk, no matter how miniscule or theoretical, that we allow ourselves to set aside the real and tangible benefits.


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## dinahx (Sep 17, 2005)

Rhogam DID contain mercury, which points to serious accountability problems that permeate pharmaceutical medicine. No one asserted that RHOGHAM has anything to do with Autism, but it is a totally plausible and yet to be disproven belief that Mercury has a LOT to do with Autism.

It can't have been disproven, to date, FTR, because there is no accepted way to test for it (trust me, due to a dental exposure I am bending over backwards to get myself tested it for it now and not having much luck), and there has never ever ever been a comprehensive screening of the blood levels of children en masse similar to what we have for Lead. No large scale quantitative analysis of the levels in children = no ability to disprove the link. I know my son has not been screened and IMO there is no point to a hair test from a scientific POV: doctors won't accept that as valid data.

I do suggest you look into Minnamata, it is so close to Autism it is very striking. This thread is not about Autism & mercury, however I believe it is related when you ask 'WHY did Rhogham ever contain this? WHY was a known neurotoxin injected into Pregnant women?'. I am 90% sure it no longer contains this, however did you know the package insert can say 'no mercury' when in fact some trace amount remains from the manufacturing process? We are only like 5-7 years from when the Mercury was removed, I think we should honor our foresisters by remembering what they went through.

Knowledge is power. Full knowledge. Informed consent. The whole idea that women can't handle a full grasp of the applicable facts is very Victorian, IMO and very much the whole 'little lady' mentality. Of COURSE I would get Rhogham if I was in a Car Accident. But that wouldn't make the risks disappear at all. And it wouldn't erase the spotty history, the historical accountability problems, etc.


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## dinahx (Sep 17, 2005)

It is a giant leap, also to go from refusing the 28 week shot, to refusing all shots, to not even treating sensitization. A really huge leap. It does not follow that because a low risk woman refuses the 28 week shot that she will even be sensitized, nevermind that she will ignore this sensitization in a future pregnancy. Indeed it would not be possible to receive legal prenatal care in the US and not have sensitization a) detected and b) treated.


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## stik (Dec 3, 2003)

Quote:


Originally Posted by *dinahx* 
I think we should honor our foresisters by remembering what they went through.

Are you suggesting that women should decline Rhogam now because it *was at one time* manufactured with mercury? Is it honoring our foresisters to pretend we face the same risks that they did? Because honestly, I prefer honor our foresisters by acknowledging that once upon a time, many, many women had one healthy baby followed by a string of dying and stillborn babies, and I am lucky to live in a place where the condition that caused that is so easily treatable.

I see that you are deeply convinced of an autism/Rhogam link. There is no way I am going to change your mind here, any more than you will change mine. I will note, for the record, that there is more mercury in an average serving of tuna than in the Rhogam shot. During my last pregnancy, I was informed that it was safe for pregnant women to have up to two servings of tuna a week.

I believe that women can handle the full facts. Here are the full facts about CJD and Rhogam:

Every human blood product carries some risk of giving you CJD. However, in years and year of use, no one has ever gotten CJD from Rhogam, which is manufactured from the plasma of a limited and exceedingly well-monitored donor pool living near Buffalo, New York. Other human blood products, including donor blood used to transfuse babies with hemolytic disease, are nowhere near as carefully monitored, and are unfiltered whole blood products that are much riskier than the carefully selected, monitored and filtered plasma used to make Rhogam. The highest risk of CJD transmission comes from beef, which is packaged and sold without a cautionary insert.


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## stik (Dec 3, 2003)

Quote:


Originally Posted by *dinahx* 
Indeed it would not be possible to receive legal prenatal care in the US and not have sensitization a) detected and b) treated.

Of course it's possible. Your HCP could be incompetent. You could decline the testing that would detect sensitization. You could lie or be misinformed about your partner's blood type or about your previous child's. Your records could be confused with another patient's. You could stop coming to prenatal visits and be lost to follow-up.

And, sadly, more women than I like to think about don't have any access to medical care except under EMTALA.


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## dinahx (Sep 17, 2005)

Quote:

During my last pregnancy, I was informed that it was safe for pregnant women to have up to two servings of tuna a week.
You were misinformed. Tuna is unsafe for pregnant women. Also, you do seem to insist on believing that our liver and kidneys are worth nothing in protecting us from disease and pollution, nor is the process of digestion worth anything? Injestion is very different from injection. I mainatain that you cannot know whether CJD has ever been transmitted by Rhogham, simply because it won't have manifested yet, and it is not routinely tested for in neonates or children.

'Less mercury than in the average can of tuna' is what was yelled at me by a dentist just before he bullied me into having 2 large amalgum fillings removed while I was nursing. I conceived a child 2 weeks later and that baby died at 10 weeks, I probably don't know what caused my m/c either right?

It is the rallying cry of mercury apologists in the media, it is extremely relativistic, and I am not buying it. I FTR would never ever eat Tuna, let alone while pregnant, and go out of my way to spend over $4 can on Wild Alaskan Salmon.

Saying it is 'okay' that Rhogham contained Thimerisol and was injected into pregnant women to achieve a very small reduction in risk so long as it isn't 'proven' to have 'caused' autism is equivalent to saying that it would be okay if Insulin turned up containing Cocaine or some other dastardly contaminant, so long as no one was documented to have died, because hey Diabetes is serious. :?

FTR I subscribe to a 'critical mass' theorey of Mercury toxicity, and we can say without hesitation that children born to mothers who received Rhogham at 28 weeks just 10 years ago had a measurably higher level of Hg at birth than children born to mothers who neither received Rhogham nor the the Prenatal Flu Shot. If anyone had bothered to measure it, which they didn't.

And also FTR, a lot of us reduce our risk of CJD from beef by only consuming grassfed beef, if we consume beef at all. I would say in the life of the average person diagnosed with CJD it would extremely difficult to determine the exact cause of the disease, precisely because it takes so long to manifest.

Just because Rhogham treats a real condition doesn't and never did give it a free pass to dose mothers with a neurotoxin, and I don't believe that accountablity has changed that much so mothers should not be cautious.

Also, maternal willingness to get Rhogham doesn't in and of itself prevent the possibility of sensitization. Every SINGLE time I have gotten Rhogham I have had to remind my HCPs and sometimes I have had to fight for it to be given in a timely fashion. If you read through Rhogham threads on here, you will see plenty of innapropriate dosing, which is risk minus benefit.

I would say this is still a very valid topic for discussion because many HCPs do not investigate whether or not the father is positive before dosing every negative woman. Or they assume she could literally be pregnant by anyone, despite her assurances to the contrary. IMO appropriate dosing of Rhogham is poorly understood at best by your average HCP on the street. Since it is a somewhat risky blood product, increased understanding is very important.


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## Peppermint (Feb 12, 2003)

Quote:


Originally Posted by *dinahx* 
It is a giant leap, also to go from refusing the 28 week shot, to refusing all shots, to not even treating sensitization. A really huge leap. It does not follow that because a low risk woman refuses the 28 week shot that she will even be sensitized, nevermind that she will ignore this sensitization in a future pregnancy.

Absolutely, I honestly am having trouble seeing the huge argument on this thread. I must have missed the people who claimed that one should *never* use Rhogam. I think almost everyone who even questions it, is simply questioning the routine 28 week shot. I didn't see anyone say "don't bother with it if you have an accident or bleed, don't bother with it if your baby tests positive after birth, etc"

FWIW- I had Rhogam with thimerosol during my first pregnancy and I am angry with myself for that, and my care providers, and the manufacturers. (and, that baby was negative like me, so- there really was no reason)


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## mom-to-jj (Sep 8, 2008)

At what point after birth is a baby's blood tested? I'm wondering how I will know if I should decline the shot after the birth. I felt like after DS was born, the doctor and nurses told me nothing about what was happening either to him or to me. I have no idea at what point I was given the second Rhogam shot, and I have no idea what my son's blood type is.

Is it incumbent upon the mother to ask that the baby's blood type be compared to her own before the shot is administered? Why don't they just do that automatically?


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## japonica (May 26, 2005)

Quote:

Absolutely, I honestly am having trouble seeing the huge argument on this thread. I must have missed the people who claimed that one should *never* use Rhogam. I think almost everyone who even questions it, is simply questioning the routine 28 week shot. I didn't see anyone say "don't bother with it if you have an accident or bleed, don't bother with it if your baby tests positive after birth, etc"
Exactly. I don't think I saw anyone here so far strictly saying that Rh neg pg moms-to-be must forego all rhogam shots. I think the discussion has centered around some of the unknowns and possible negatives of the product and what some of the options are (no prenatal shot, shot at delivery after blood testing, kleihauer-betke test). Even a pregnancy with an Rh positive father might result in a Rh negative baby, if the father is heterozygous for that particular antigen.

Quote:

I never said the shot was uber-risky, I said in my posts that the risks of getting the shot are very small, i was just trying to emphasize that it's not risk free.

my midwives couldnt understand why i didnt want it because in their mind it was risk free. but no medicine is completely risk free.
It would also be worthwhile to remind midwives and OBs that not only might there be risks involved, but with the reported 1% failure rate, someone is going to get sensitized, even when everything is done correctly. I found it frustrating that OBs assume that 99%=works every time, so when you have a group of women who find themselves sensitized, it's a shock because OBs sell it as foolproof. It would be better to tell patients right off the bat, "there is the small chance that this will not work," so that if isoimminuzation does occur, the patient was told in advance, not "hey, how did this happen?"

Quote:

don't understand why no one is taking Japonica's loss and her theorey about why it happened seriously! It is upsetting me a great deal. Of course unknown viruses could be transmitted!
It is not my intention to panic or upset others, but I am just relating my experiences with this product. After a full term stillbirth, believe me, we get screened and tested for everything under the sun. And we get genetic testing, karyotypes done etc. That said, the screening is for known infectious agents, so anything unknown would not be on their radar, so to speak. And we had a full autopsy and pathology of the placenta done. What started me wondering was the pathology report of the placenta showing that *something* caused an immune reaction which led to a massive inflammation that gradually choked off all blood flow. Then the autopsy documented the IUGR rates and coincidentally it started right after my last winrho shot. So, there's is no definitive answer, just a lot of coincidences that seem to point in a certain direction. And I had two successful pregnancies since then (even sensitized) so there was no inherent immune issues or clotting issues with me. And I did not have any additional winrho shots since then either (no point since I was already sensitized, although the nurses at the OB practice kept insisting I needed them). My instinct is that the winrho did have some part to play in my first child's death. But I don't have the "proof" for it and whatever people want to do with that opinion is up to them. I read hundreds of stories of parents whose children have suffered permanent disability or life-altering reactions to vaccines and I don't discount them as just anecdote nor do I take them as scientific fact. I incorporate their experiences in with all the other information I read about a product from a multitude of sources and go from there.


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## littlecindy (Feb 14, 2008)

i got the 28 week shot without question. and then my son turned out to be a negative blood type anyway. so i figure my next child is at a lesser risk, because there's no way i could be sensitived already, right?

so i am trying to figure out what to do when i'm pregnant next time. i hate to get any shot without looking at whether it's really needed for me and my situation. i measured small with my son at 36 weeks. i was right on track, he was even a bit big until my 36 week appt. but a lot of things happened from 28 weeks to 36 weeks besides the rhogam (my sister almost died, and my son turned head down which i'm guessing was the biggest factor).


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## SallyN (Feb 5, 2008)

I'm just going to chime in for those concerned about RhoGam being a blood-derived product... some places now use the patient's own blood. (You get a blood draw, lab does it's *thing* and the next day you go back for the injection.)


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## dinahx (Sep 17, 2005)

That is SO interesting, please tell us more! <3


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## sarabecca (Feb 5, 2006)

I know next to nothing about this topic, but I recently read about something that might be interesting to some of you. Here's the link:

Quote:

Biocept, an emerging leader in biotechnology, will launch I.D. Rh(D), the first in a series of noninvasive prenatal diagnostic tests that can be performed with a simple maternal blood sample, at the Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, May 3-7 in New Orleans.

The I.D.Rh(D) test diagnoses the Rh(D) status of a fetus in an Rh(D)
negative pregnancy, and can be performed as early as ten weeks of gestation. The test isolates fetal DNA circulating in the mother's whole blood...
Read the whole thing here: http://www.reuters.com/article/press...08+PRN20080505


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## Peppermint (Feb 12, 2003)

That is awesome!


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## littlecindy (Feb 14, 2008)

Quote:


Originally Posted by *mom-to-jj* 
At what point after birth is a baby's blood tested? I'm wondering how I will know if I should decline the shot after the birth. I felt like after DS was born, the doctor and nurses told me nothing about what was happening either to him or to me. I have no idea at what point I was given the second Rhogam shot, and I have no idea what my son's blood type is.

Is it incumbent upon the mother to ask that the baby's blood type be compared to her own before the shot is administered? Why don't they just do that automatically?

i have my medical records from my son's birth and i believe they must've tested his blood right away, because i don't *think* i got the shot. (he's a negative blood type like me). i don't remember getting it and it's not in my records, but they might've given it to me. next time i'll definitely ask beforehand how it will all work!


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## nashvillemidwife (Dec 2, 2007)

Blood is tested immediately with a sample from the umbilical cord. Some midwives test right there on the spot with an Eldon card. I don't trust them so I send mine to the lab.


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## mwherbs (Oct 24, 2004)

so there is a test that can be done in pregnancy that determines Rh factor of your baby- it isn't an invasive test and so there is no risk of creating sentization by having the test done I found out about it from another midwife the company who will test a pregnant mom's serum to get info about baby's RhD status- it is approved in NY this would give you info about baby's blood so you could decide to get the Rh prentatal shot or not --- I haven't used this lab and don't know much more about it- I mentioned it before and maybe someone else on MDC has contacted this lab and had it done---

Lenetix® Medical Screening Laboratory, Inc.
174 Mineola Boulevard
Mineola, New York 11501

and here is a web page link-- http://www.lenetix.com/

so that could eliminate some of the concerns about safety for Rh- babies being exposed unnecessarily --


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## MrsB2008 (Sep 17, 2009)

I am 26 weeks pregnant and Rh-, my husband is Rh+ and my midwife wrote me a script for the 28 week RhoGam shot. i am hesitant to get it and as of right now would like to pass but have Baby's blood tested at birth and if baby is Rh+ then i would get the shot.

i have been reading the threads on here so far but i have question that i haven't found answered yet.

what are the risks to BABY by not getting the shot at 28weeks?

thanks ladies!


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## nashvillemidwife (Dec 2, 2007)

There is a very minimal risk to this baby. Because it takes some time for you to build antibodies once sensitization occurs, the incidence of effects on the fetus during the same pregnancy as when you become sensitized are extremely rare. It is so rare that I've never seen reported statistics. That's not to say it's not possible, but much less likely than in subsequent pregnancies.


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## hapersmion (Jan 5, 2007)

Oh, thank you for that link, mwherbs!







I was just asking the backup OB about this test the other week, and he didn't know what I was talking about - said he thought it could only be done by amnio, and was generally not much help.

To the OP, I am having trouble deciding about this as well. I don't like the risk that the baby's blood might be attacked by the rhogam (so frustrating that there's no data!), and I don't like the risk of getting sensitized and having to deal with all the medical stuff in a future pregnancy. My midwife doesn't routinely do the prenatal shot, but I had a sensitization scare after my miscarriage (turns out the anti-D reading was just from lingering Rhogam, I'm negative for it now, yay!), and so I had a while to think about what it would be like to be sensitized, and I'm not really comfortable just skipping the shot. Plus, I had two shots while pregnant with DS (one routine, one after an external version, and I had to keep pestering them to bring it to me), and he was very healthy.







So lately I've been leaning towards getting the shot.

Still, I really like the option of testing to find out if the baby is positive or not! I was upset when the backup OB wouldn't try it - I'll have to see about this website, I wonder if my midwife could just do the blood draw herself.

One more test that hasn't been mentioned on this thread is called the Kleihauer-Betke test, and it's been around long enough that most OBs should be able to do it. It tests to find out how much fetal blood is in your circulation. If they find a lot, it's possible that you might actually need more than the standard Rhogam dose - that might be why some people still get sensitized even when they get the shot. However, it isn't perfect. I've been looking into it as hard as I can, and there's a chance that it won't detect really small bleeds. It's still worth doing, I think, to make sure you aren't having a really big bleed, but if you get a negative result it isn't a 100% indication that you don't need Rhogam, you'd still be stuck with that decision.

It's very annoying, actually. Why don't they know everything by now?!? I want hard data!


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## Kidzaplenty (Jun 17, 2006)




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## EmmaWoodhouse (Jul 2, 2007)

There is another factor that no one has mentioned that I know of, and it is the ABO sensitization. Yes, it does factor in with your chances of becoming sensitized with the Anti-D. If the mother is type O and the baby is either A or B, there is sensitization there too that can cause a milder reaction. However, with that sensitivity, the type O woman is less likely to develop antibodies for the rh incompatibility. So, the 1.8% goes down even further for those women. I believe that is anther factor that should be considered when deciding to get the Rhogham or not.


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## ~Pony~ (Nov 12, 2009)

reviving this thread a little








I was searching MDC for info in SCH and rhogam.
I am 6 weeks and they found a very small active bleed on ultrasound yesterday.
I am Rh- and DH is +
My doctor said she was not too concerned about the SCH but then next sentence asked if I had had my Rhogam shot yet.

I had the shot at 28 weeks when I was pregnant with my DD who is now 3

I was planning on waiting until this baby was blood typed to make a decision about Rhogam, but wondering what everyone's opinion is about having it at 6 weeks because they know I am bleeding.

FWIW I am asymptomatic for the SCH. I got the US to date the pregnancy, the SCH was kind of a surprise


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## MeepyCat (Oct 11, 2006)

Quote:


Originally Posted by *~Pony~* 
reviving this thread a little








I was planning on waiting until this baby was blood typed to make a decision about Rhogam, but wondering what everyone's opinion is about having it at 6 weeks because they know I am bleeding.

Pony, one of the main arguments against routine administration of RhoGam during pregnancy is that, in the absence of bleeding or abdominal trauma, the chance of sensitization occurring is very low, because the chance of maternal exposure to the fetal blood is very low. The argument is that, unless there's some reason to believe that maternal and fetal blood are mixing, the shot isn't actually necessary.

This doesn't apply to you right now - you're bleeding. The odds that you are being exposed to fetal blood is high, and there's at least a 50% chance of Rh factor incompatibility. When I was in your shoes (with bleeding from a miscarriage at 10 weeks, and later with bleeding from placenta previa in the late 2nd trimester), I felt that getting Rhogam was the right thing to do.


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## ~Pony~ (Nov 12, 2009)

Thanks for the quick reply, that is what I was thinking.
I just was not sure, with it being so early in this PG, if the baby even had a bloodtype yet.
But I suppose if the SCH continues to bleed I will eventually have to get the Rhogam shot anyway though, right.

My Dr. really did not seem concerned about the SCH but it just spooked me a bit that she wanted me to run in and get the Rhogam.
Thanks again


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## nashvillemidwife (Dec 2, 2007)

Before 12 weeks, the mini-dose (120 mcg) is appropriate. You might ask the doctor about that. The thing to remember is that even though you are only 6 weeks and the bleed is very small, the Rhogam will circulate in your system for 12 weeks, so getting it now is the very best thing you can do to prevent sensitization if the bleed continues or gets worse. If you wait it could be too late, whereas if you do it now it continue to protect you.


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## is it puppies? (Oct 30, 2009)

EmmaWoodhouse-- where can I find more info regarding the ABO incompatibility affecting the likelihood of getting sensitized? I am O- and really don't want to get the shot even though my dr. wants to give it to me at 26 weeks, I am trying to find as much info as I can to try to get her to discuss it with me logically and not just get pissed off which she did when I brought it up at our first visit.
thanks


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## HappyMommy2 (Jan 27, 2007)

To the OP: Looks like you are getting a lot of info, possibly still some conflicting and confusing info. So i thought you might want some ideas about what other mamas have done.

I am Rh-neg. With baby#1, I was "mainstream" and ended up with an unnecessarian. I took the shot at 28w and again after surgery.

With baby #2 (after reading lots) I chose NOT to get the 28w shot, and then after the baby's blood type was tested, I DID have to get the shot after giving birth at home.

I wanted to leave my options open for future pregnancies.


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## japonica (May 26, 2005)

Quote:

One more test that hasn't been mentioned on this thread is called the Kleihauer-Betke test, and it's been around long enough that most OBs should be able to do it. It tests to find out how much fetal blood is in your circulation. If they find a lot, it's possible that you might actually need more than the standard Rhogam dose - that might be why some people still get sensitized even when they get the shot. However, it isn't perfect. I've been looking into it as hard as I can, and there's a chance that it won't detect really small bleeds. It's still worth doing, I think, to make sure you aren't having a really big bleed, but if you get a negative result it isn't a 100% indication that you don't need Rhogam, you'd still be stuck with that decision.
I had this done and it came back positive but we didn't find out until weeks after delivery. So, yes, it's a good indication that something is going on, but you need competent medical staff as well to make sure you get that larger dose of rhogam within the 72 hour window or I guess that's it. Well, that was our experience.

Quote:

There is another factor that no one has mentioned that I know of, and it is the ABO sensitization. Yes, it does factor in with your chances of becoming sensitized with the Anti-D. If the mother is type O and the baby is either A or B, there is sensitization there too that can cause a milder reaction. However, with that sensitivity, the type O woman is less likely to develop antibodies for the rh incompatibility. So, the 1.8% goes down even further for those women. I believe that is anther factor that should be considered when deciding to get the Rhogham or not.
Interesting, Emma. Do you have links for that? Just curious because I'm O- and with my first sensitized pregnancy, she was O+ and my anti-D titers rose throughout the pg. With my second sensitized pregnancy, he was B+ and my titers, even though they were higher, flatlined and stayed constant through the pg. And yeah, I tested positive for B antibodies after his birth. I've never heard of this before, but it's fascinating to think about.


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## is it puppies? (Oct 30, 2009)

Japonica- I have been trying to find info on how ABO and RH incompatibility can work to offset each other since I am also O-. I found a few research articles online from the 60s and 70s and if I have understood what I read the A or B or AB blood type entering your bloodstream will be killed by your blood too quickly for you to form antibodies against the RH- part of the blood, it will just be destroyed, so you will not form the antibodies.

While doing the figuring, on a very basic assumption that with my husband who is A+ (but whose father is A-) and my O- (with an A+ mom so I assume I carry that) my babies have a 3/4 chance of being A type in which case if any A type blood enters my bloodstream it will be killed by my blood whether or not it is RH+ or RH-. The baby will also have a 1/2 chance of being RH - since DH and I each carry the + and the -. I haven't looked into whether it's those simple of percentages.

The only way that this theory would not work is if the baby carries O+ because my blood would not kill off the O but only create antibodies to the RH+. This is totally my theory based on what I read and I really have no idea yet just what the likelihood actually is of the baby inheriting either the A or O type, or the +/-, as that was just too much for me to look into, but I do feel satisfied with my numbers and it eases my mind for now









I have the title of one of the articles I read:
the inhibiting effect of ABO incompatibility on RH immunization
but I'm not sure if that one talked about the right thing, but they were all on the same website if you wanted to search it.


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## hapersmion (Jan 5, 2007)

Just a small note, Is it puppies? - if you're O neg, you can't carry A genes or rh-positive genes. Both of those traits are recessive, meaning that you have two O genes and two rh-negative genes, nothing else. You're right that your husband must have one positive and one negative gene, and your kids still have a 50/50 chance of being rh-neg.









As for the A gene, unless you know your husband's parents' blood types, he could be either AA or AO. If he's AA, then all your children will be A. If he carries the O gene (AO), then they once again have a 50/50 chance of being A or O. So I guess if you put them both together you could call that a 3/4 chance, if you put them both together.









Sorry if you already knew all that, but I always loved doing Punnet squares in biology and figured I'd go through it if you were interested.


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## is it puppies? (Oct 30, 2009)

This is the part that I actually haven't looked into yet, after trying to decipher the articles I fried my brains and they still haven't recovered enough to try to understand that stuff








so if I get you-- I can only carry O and Neg even if my mom was A + ? I wasn't sure about that. But it seems like it would sort of make sense after some of the things I read but haven't really deciphered yet








My DH's mom is A+ and his dad is A- so can I assume he is AA+- (not sure if I put that correctly but I think you get it)?
So my figuring, though not quite right, still mostly works out if the theory is at all correct









I also remembered after my last post, that in the ABO incompatibility the A is the "least" incompatible with the O, so that there would be little likelihood of any problems occurring and that the way I do my science







the baby is most likely to be A+ or A- and very unlikely to suffer from RH incompatibility and only mild jaundice if at all being A. I think that B and AB had the potential for a more severe reaction from ABO inc.


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## is it puppies? (Oct 30, 2009)

http://www.moondragon.org/lab/abod.html

not that this site looks very scientific, but it does sort of explain stuff. The other thing that I was planning to look into is the Duffy factor (?) which I think means that the blood is practically positive anyways- but I don't really understand how that works.


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## hapersmion (Jan 5, 2007)

Yep, you can only have O and Neg genes - if you had an A and a Pos gene, you'd be A and Pos, since those genes are dominant.









You still can't assume that your DH is AA, unfortunately. One of his parents could still have been carrying the O gene, which wouldn't show up, since it's recessive, and he could still have an AO blood type (effectively A, but it means that your children could still possibly end up getting the O gene from him, and then they would be O). Since neither of his parents was O, the chances are better that he's AA, but you can't tell for absolutely certain.

You can assume that he's +-, yes.







And your figuring did still come out right, so none of the rest of it really matters except for interest's sake.

Unfortunately all I know about the ABO incompatibility stuff is what I've read in this thread.







I'm A, so it doesn't help me - but it's certainly interesting.


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## japonica (May 26, 2005)

Puppies, Do you mean Duffy antibodies? That's another antibody issue, aside from the Rh stuff.

Quote:

You still can't assume that your DH is AA, unfortunately. One of his parents could still have been carrying the O gene, which wouldn't show up, since it's recessive, and he could still have an AO blood type (effectively A, but it means that your children could still possibly end up getting the O gene from him, and then they would be O). Since neither of his parents was O, the chances are better that he's AA, but you can't tell for absolutely certain.
Yup, my DH is B+, yet our daughter is O+. You never know how the genetics will play out. He also has siblings who are B-, O-, and O+. Lots of variation there.


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## is it puppies? (Oct 30, 2009)

_Du FACTOR (Duffy factor)

The Du factor is related to the Rh group of blood factors. It is important because in cases where the Rh group is missing (Rh-), the Du factor is sometimes present. In such situations, the Du factor usually compensates for the lack of other Rh factors and causes the blood stream to respond as if it where Rh+. Such cases would be reported as Rh- Du+. These women are RARELY at risk for Rh problems and are most often treated as if Rh+ (except with a transfusion)._

that is probably too much to quote, but I've done it









I don't really understand how it applies, except that it means that whoever has it doesn't have to worry about RH incompatibility!


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## japonica (May 26, 2005)

I think we're talking about different antigens...here is the one I was referring to:

http://emedicine.medscape.com/article/974349-overview

Quote:

Although the Rh antibody was and still is the most common cause of severe hemolytic disease of the newborn, other alloimmune antibodies belonging to Kell (K and k), Duffy (Fya), Kidd (Jka and Jkb), and MNSs (M, N, S, and s) systems do cause severe hemolytic disease of the newborn.3
And from that same article:

Quote:

The risk of Rh immunization after the delivery of the first child to a nulliparous Rh-negative mother is 16% if the Rh-positive fetus is ABO compatible with its mother, *2% if the fetus is ABO incompatible*, and 2-5% after an abortion. The ABO-incompatible RBCs are rapidly destroyed in the maternal circulation, reducing the likelihood of exposure to the immune system. The degree of Rh sensitization of the mother is directly related to the amount of fetomaternal hemorrhage (ie, 3% with <0.1 mL compared with 22% with >0.1 mL).
Wow, I never knew that. Guess we learn something every day.


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## is it puppies? (Oct 30, 2009)

hey that is a great quote regarding the ABO incompatibility- can you give me the source? I would like to give it to my Dr.

whoops, I just realized it's in that same article you posted, I just didn't see it at first!


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