I didn't receive a Rhogam injection after my last birth (third baby) and am considering another pregnancy. I'm 44 years old and have no other health issues. Obviously the place to start is to have my son typed so that we'll know if there is an issue at all. But assuming that he is a positive blood type, what role would the early injection play in my prenatal care? Would the early injection safeguard my pregnancy? What should I be concerned with and considering regarding this issue as I contemplate what would be my final pregnancy?
-Eisa Morris, Tennessee
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I'm very concerned by some readers' attitudes toward Rhogam injections. My grandmother had her five children before the Rhogam shot was widely used (she is Rh neg. and my grandfather is Rh pos.). As a result of not having the shots, her 2nd, 3rd, and 4th babies had slight brain damage and lower IQs. Her 5th baby died shortly after birth due to the Rh incompatibility. The first baby (my mother) was unaffected, as most 1st Rh babies are.
Not all medical intervention is bad. Some saves lives and reduces suffering. If my grandmother would have received the Rhogam injection after my mother's birth, the other children would have been fine. Rather than listening to opinions, women need to find out the real facts. It is your responsibility to your children and your unborn children.
-Anon.
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RhoGam is the original Rh immune globulin. It was introduced in 1968. It is a specially prepared gamma globulin that contains a concentration of Rh antibodies. These antibodies suppress the Rh negative mother's immune response to the foreign Rh positive red blood cells that may enter her bloodstream during pregnancy or following an abortion or full term delivery. RhoGam is derived from Rh-sensitized moms or Rh- males that have been sensitized through blood transfusions.
In 1984, ACOG recommended that an antepartum injection of RhoGam be given to all pregnant Rh- women at 28 weeks gestation. It was reported that the incidence of immunization can be further reduced from 1.6% to less than 0.1% by administering Rh immune globulin in two doses.
I myself do not totally agree with this procedure. In my practice a routine antibody screen is done at the initial prenatal visit. I screen all my Rh- mothers, primips or multips. If they have a negative titer, I do not feel the antepartum injection is necessary. First of all, a primip would have not had any time to build up immunities. She does not need RhoGam if she has not had any transfusions, abortions etc. My biggest objection to antepartum RhoGam is the fact that the baby can be born direct Coombs positive from the RhoGam injection itself. This is one of the contraindications, although rarely mentioned by the drug company or physicians. I have seen this scenario, where the baby had to be transfused after delivery because of antepartum RhoGam.
After my deliveries, I type babies and if they are positive, then the mother is given RhoGam. Some of my mothers refuse the RhoGam and I respect their decision. They have birthed 6-7 Rh+ children and have never received one dose of RhoGam and they still test negative on their titer. On the other end of the spectrum, I worked with a woman who had a miscarriage early in her marriage and became sensitized--her healthcare provider didn't tell her about the chances of her becoming sensitized because of her Rh factor. She became highly sensitized 1:250 dilution or higher. She continued to have 7 Rh+ babies who all needed to be transfused. She has had two more children who were born negative.
RhoGam can be a sensitive subject and each person needs to research the answers. As far as contracting HIV from RhoGam, I'm sure that it has happened but within the last few years, the process of filtering the product has gone through major changes and it is micro filtered over and over again, one reason why the cost of RhoGam has risen from $25 from when I first started practicing to over $100 on today's market.
-Cathy O'Bryant CPM
Reprinted from Midwifery Today E-News (Vol 1 Issue 51, Dec 17, 1999)
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