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Anyone rhesus sensitized recently pregnant?


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#1 nonny1

Posted 14 January 2013 - 02:46 PM

Hi,


I unfortunately became rhesus D sensitized during my first pregnancy. In my next pregnancy the obstetrician was monitoring my titer levels but we lost the baby at 15 weeks due to chromosomal issues.

We are ttc again. The ob has said that next time around (if we are so lucky) the titer levels will not be an accurate way to see if problems are developing.

I'm interested to hear from anyone who is rhesus sensitized and has recently been pregnant. How did they monitor your pregnancy? If I fall pregnant again should I not be looking for a foetal-maternal specialist? Would my normal ob have to refer me? Did your baby need intra-uterine transfusions? Where were these done? Did your baby have any complications at birth or any complications later on?

Are there any support groups for ladies going through a rhesus sensitized pregnancy?

Any advice would be appreciated.

Thanks

#2 tibs

Posted 14 January 2013 - 02:51 PM

Sorry for your loss sad.gif   Didn't the anti-D work in your first pregnancy?

Not me personally but there was an EB'er called Karen who had was rhesus sensitised, she went on to have a baby that was affected and needed in utero transfusions but while born prematurely is otherwise healthy original.gif  I know she saw a special expert Obstetrican and was monitored very closely through her pregnancy.  Hopefully she is still around to share her story, she is a lovely lady who even makes little gowns for all the premmie babies original.gif



#3 Girlo

Posted 14 January 2013 - 02:55 PM

Is rhesus sensitise different to rhesus negative?? I am rhesus negative (but have only had one baby), is this something I need to think about?

Sorry, I can't offer any help OP, but I will be watching replies.

#4 Corella

Posted 14 January 2013 - 03:01 PM

Your antibodies to Rh+ should be checked if you are Rh- to make sure you're not sensitized.
I have a friend who was sensitized due to a mmc and needed close supervision in her pregnancy - her baby was at risk of becoming anemic and hydropic? I think was the term. He was in the end a Rh- baby too so it wasn't a problem.

#5 tibs

Posted 14 January 2013 - 03:15 PM

QUOTE (Girlo @ 14/01/2013, 03:55 PM) <{POST_SNAPBACK}>
Is rhesus sensitise different to rhesus negative?? I am rhesus negative (but have only had one baby), is this something I need to think about?

Sorry, I can't offer any help OP, but I will be watching replies.


If you are rhesus negative you can become rhesus sensitised if some of your baby's blood manages to mix with yours (if baby is rhesus positive).  This is why the 2 anti D injections during pregnancy and one after birth of a Rh+ baby are so important, as are Anti D injections after any bleed during pregnancy or after miscarriage or D&C.  I'm also Rh- and my DH has a ++ blood type so this is a big concern of mine.

#6 Natttmumm

Posted 14 January 2013 - 03:40 PM

I thought the anti D injections prevent that. I have had them for all my pregnancies.
I have negative blood and DH is positive. Both kids are positive.
Is this a different condition??

#7 Mousky

Posted 14 January 2013 - 03:55 PM

Anti D injections are routinely gives at 28 and 34 weeks gestation and after birth.  They need to be given within 72 hours of any bleed. Unfortunately, not all bleeds are obvious.

If you have a hidden bleed during your pregnancy, you will not know to have an anti D injection and then may become sensitised.

Also unfortunately, not all ob's will educate you on your need for anti D if you have a bleed. My first ob didn't offer it to me when I had my first missed miscarriage, even though I did start to bleed four days before the D&C (I had to wait 10 days), which was where I had the anti D. I was not sensitised thankfully, so s/he must have also been rh-.

So there unfortunatdly are reasons that some women wont get the anti D when needed and may go on to be sensitised.

#8 tibs

Posted 14 January 2013 - 05:30 PM

QUOTE (Mousky @ 14/01/2013, 04:55 PM) <{POST_SNAPBACK}>
Anti D injections are routinely gives at 28 and 34 weeks gestation and after birth.  They need to be given within 72 hours of any bleed. Unfortunately, not all bleeds are obvious.

If you have a hidden bleed during your pregnancy, you will not know to have an anti D injection and then may become sensitised.

Also unfortunately, not all ob's will educate you on your need for anti D if you have a bleed. My first ob didn't offer it to me when I had my first missed miscarriage, even though I did start to bleed four days before the D&C (I had to wait 10 days), which was where I had the anti D. I was not sensitised thankfully, so s/he must have also been rh-.

So there unfortunatdly are reasons that some women wont get the anti D when needed and may go on to be sensitised.


That is disgraceful that your Ob was so blase.  I've had a missed miscarriage and was booked the next week for a D&C but my Ob stressed that if I started to bleed I had to get the Anti D pronto.

#9 deejie

Posted 14 January 2013 - 08:07 PM

It is unusual in modern obstetrics for a women to be Rhesus isoimmunised. The introduction of preventative administration of Rh(D) immunoglobulin has done an amazing job of reducing the rate of Rhesus sensitisation.

Can a regular private OB handle an immunised pregnancy? Yes. But there are some who encounter it far more frequently. These OBs work within tertiary maternity hospitals and are more experienced in these matters than their private counterparts. Your GP can refer you directly.

Antibody titres are not the most reliable indicator of antibody "strength" anymore. Certainly a titre of 2048 for example is far more dire than a titre of 4, but there are many difficulties in standardising the reporting across different laboratories. Mostly the titres are still done for base reference, but certain antibodies including Anti-D can now be officially quantified.

The Rhesus type of your baby to determine their blood group used to be determined by extraction of material by amniocentesis. Of course this carried a small associated risk. These days, fetal DNA can be extracted from your blood sample from the mid second trimester onwards and typed for the Rhesus system.

If your titre/quant puts you in the "at risk" category, your baby used to be monitored by serial bilirubin levels in the amniotic fluid. This again required amniocentesis. These days, the vast majority of monitoring is done by MCA (middle cerebral artery) velocity which is measured by ultrasound. The premise is that as the antibody destroys baby's red blood cells, the baby becomes more anaemia. So the baby's heart beats faster to pump a smaller mass of red cells around the body quicker to provide oxygenation. Because the heart beats faster, the blood moves quicker. So an ultrasound of the MCA in an anaemic baby would show very fast flowing blood when compared with a non-anaemic baby (I hope this makes sense). The procedure is completely non-invasive.

If you do require intra-uterine transfusions, these are done in hospital using ultrasound to target the umbilical blood vessel. The procedure itself is very quick and you are usually kept for a short period of observation/fetal monitoring afterwards.

I'm not sure if there are any buddy groups on EB especially for immunised women. There used to be a High Risk Pregnancy buddy group a while ago, I'm not sure if it is still active.

I hope my post helps out. Feel free to PM me if you have any questions.

All the best original.gif



#10 nonny1

Posted 14 January 2013 - 10:00 PM

Thanks for all the replies especially deejie. I'd come across a lot of that info by googling but it was mostly in quite technical articles so it was great to have it explained so clearly.

For those who are wondering how I became rhesus sensitized - well it was partly my fault and I feel terrible about it. I had always been told (by my parents) that I was A+ and my first obstetrician never insisted on testing me. During my first pregnancy I did all the other tests and could kick myself (and him) now for skipping that one. It was only after the birth of DD (about a month after) when some of the paperwork had me down as O+ that I thought to have it checked. Turns out I'm A-. Then had hubby checked and he tested O+ (after always believing himself to be A+). You'll be pleased to know that this was not in Australia. When I next fell pregnant my titre levels were checked and I had become sensitized.

#11 CoFFeELoVe

Posted 14 January 2013 - 10:11 PM

Hi Nonny,

Deejie said it all really original.gif

I've had 5 pregnancies after I became iso immunised. I was always under MFM at the hospital. Regular bloods and scans, and based on those results determined the treatment during pregnancy, eg transfusions, early induction etc.

Remember that pregnancy is the first part, the jaundice after birth is the other issue.

My last DD was 10 days in special care with her niggly jaundice.
It was a nightmare to try and control!

FWIW my babies were never severely affected, all were induced early (35-36 weeks) so it really does depend on each woman as to how things go.

Good luck, it's certainly not doom and gloom, the MFM specialists really know their stuff original.gif

#12 tibs

Posted 14 January 2013 - 11:33 PM

QUOTE (nonny1 @ 14/01/2013, 11:00 PM) <{POST_SNAPBACK}>
Thanks for all the replies especially deejie. I'd come across a lot of that info by googling but it was mostly in quite technical articles so it was great to have it explained so clearly.

For those who are wondering how I became rhesus sensitized - well it was partly my fault and I feel terrible about it. I had always been told (by my parents) that I was A+ and my first obstetrician never insisted on testing me. During my first pregnancy I did all the other tests and could kick myself (and him) now for skipping that one. It was only after the birth of DD (about a month after) when some of the paperwork had me down as O+ that I thought to have it checked. Turns out I'm A-. Then had hubby checked and he tested O+ (after always believing himself to be A+). You'll be pleased to know that this was not in Australia. When I next fell pregnant my titre levels were checked and I had become sensitized.


Don't feel bad you weren't to know.  My parents are both A+ and had told me I was too - not that they had had me tested I guess they just figured since they were both A+ I would be too.  I only found out I was A- when I first became pregnant and had my bloods done - I think blood group is a standard preg bloods test here in Australia.  My parents still don't believe I am A-  blink.gif  Especially since all 3 of my kids are also A+ (my husband is O+).


#13 nonny1

Posted 15 January 2013 - 06:15 AM

QUOTE (pukeko~ponga~tree @ 14/01/2013, 11:11 PM) <{POST_SNAPBACK}>
I've had 5 pregnancies after I became iso immunised. I was always under MFM at the hospital. Regular bloods and scans, and based on those results determined the treatment during pregnancy, eg transfusions, early induction etc.


Good luck, it's certainly not doom and gloom, the MFM specialists really know their stuff original.gif



5!! Wow and congratulations biggrin.gif That makes me feel SO much better. We only want one more. Does every hospital have a MFM unit? At what stage in pregnancy do you go to them? I'm based in Sydney - I presume my gp or ob would know where the best hospital to refer me to would be once pregnant?

#14 nonny1

Posted 15 January 2013 - 06:30 AM

QUOTE (tibs @ 15/01/2013, 12:33 AM) <{POST_SNAPBACK}>
Don't feel bad you weren't to know.  My parents are both A+ and had told me I was too - not that they had had me tested I guess they just figured since they were both A+ I would be too.  I only found out I was A- when I first became pregnant and had my bloods done - I think blood group is a standard preg bloods test here in Australia.  My parents still don't believe I am A-  blink.gif  Especially since all 3 of my kids are also A+ (my husband is O+).


Thanks tibs - I'll try not to. Blood groups are weird. Its a good thing they're so pedantic here in Australia about testing because I think a lot of people make the same mistake (2 x + must equal +...but it doesn't always).

Its only since I've developed this problem that I've found out that we actually each have two signs after the letter:

For example if you're A- then you're actually A--. But if you're A+ then you could either be A++ or you could be A+-.

I'm not an expert but i reckon your husband is O++. The reason I think this is because my husband has been referred for his phenotype and apparently if he tests A++ then any baby of ours will be rhesus +. If he tests A+- then there is a 50/50 chance the baby will be rhesus -.

#15 CupcakeMumma

Posted 15 January 2013 - 07:43 AM

I'm  rh- AB and hubby is  a+ , so we have a B-, A+, B+ and a AB -, and yes I've had anti d a lot.  With monitoring and a good ob, things should be a okay for you original.gif.

#16 CoFFeELoVe

Posted 15 January 2013 - 09:15 AM

QUOTE
5!! Wow and congratulations  That makes me feel SO much better. We only want one more. Does every hospital have a MFM unit? At what stage in pregnancy do you go to them? I'm based in Sydney - I presume my gp or ob would know where the best hospital to refer me to would be once pregnant?


As soon as i went to my GP a referral was sent to the specialist. I'm positive Sydney will have a MFM unit. In NZ, i wasn't seen until 16-18 weeks by the Rhesus clinic ( As they were called!), in Brisbane i was 12 weeks when i saw MFM.

#17 deejie

Posted 15 January 2013 - 10:46 AM

QUOTE (nonny1 @ 15/01/2013, 07:15 AM) <{POST_SNAPBACK}>
5!! Wow and congratulations biggrin.gif That makes me feel SO much better. We only want one more. Does every hospital have a MFM unit? At what stage in pregnancy do you go to them? I'm based in Sydney - I presume my gp or ob would know where the best hospital to refer me to would be once pregnant?


See your GP when you are pregnant and they will be able to refer you to the nearest MFM unit.They are usually located in tertiary level hospitals and there are several in Sydney.

As P~P~t said, the MFM specialists really know their stuff, you will be in the very best of hands. They will typically see you after the first trimester, somewhere between 12-16 weeks depending on your initial titre/quant level. It's certainly not doom and gloom as the internet might have you believe. I have worked with them in two hospitals and although sometimes it can be a long and stressful haul with premature babies, transfusions and long stays in special care, I can't remember anyone who didn't bring home their little baby at the end.

All the best.

#18 nonny1

Posted 15 February 2013 - 05:58 PM

Hi ladies,

It's me again. Well I'm 4 1/2 weeks pregnant (I think). I did the usual pregnancy blood tests yesterday plus the rhesus titer. My GP just called to say it's in the 1000's!!! She wants to see me on Monday to refer me to an ob but said this could indicate this baby has rhesus disease and if I have any bleeding or feel ill over the weekend I must go to the hospital. I'm seriously freaking out now...this is not the call I wanted to get at 6pm on a Friday evening...


Is this as bad as she's making it sound? Could the levels not be off because of my tfmr last year? I thought the titers weren't reliable for 2nd or later sensitized pregnancies? Please tell me there is some hope....

#19 my4beautifulboys

Posted 15 February 2013 - 06:44 PM

I was just reading as i'm rhesus negative also, with my three children ive had all the Anti -D injections, ive also had 3 m/c since, and after the two, which ended in a D&c i think i had the Anti -D. But i did have a Mmc in November last year, and that was a natural m/c, so i didnt have the Anti-D then.

Now i'm pregnant again and i'm 5 weeks now. Is it ok that i didnt have the Anti-D after my last m/c or not. I will be seeing my Gp next week, should i suggest to him that i have a blood test to check?

Thankyou and best wishes to you all.

#20 nonny1

Posted 16 February 2013 - 04:37 AM

Hi my3beautiful boys,

I think I read somewhere that the chances of becoming sensitised during the 1st trimester are quite low. Also the rhogam lasts for a while so you might have still been covered from a previous shot.

I would mention it though to your GP next week. They can add the test to all the other normal pregnancy ones. I think it would be good to check - I'm all for checking and double checking after the mistake that got me to this place.

#21 my4beautifulboys

Posted 17 February 2013 - 03:03 PM

hi  nonny1, thanks for youre reply. Im going to be seeing my Gp this week so i ll definately mention that to him, perhaps he could include a blood test in with the other routine ones to check for sensitisation.

I think its easy to be overlooked for that particular blood group that we are Rh-, and its quite rare. I think that sometimes they need reminding! Which doesnt seem right.

My 3 children are all + type blood groups, so they get that from Dh, and not me. So Its very important.

All the best.

#22 deejie

Posted 17 February 2013 - 07:09 PM

QUOTE (nonny1 @ 15/02/2013, 06:58 PM) <{POST_SNAPBACK}>
Hi ladies,

It's me again. Well I'm 4 1/2 weeks pregnant (I think). I did the usual pregnancy blood tests yesterday plus the rhesus titer. My GP just called to say it's in the 1000's!!! She wants to see me on Monday to refer me to an ob but said this could indicate this baby has rhesus disease and if I have any bleeding or feel ill over the weekend I must go to the hospital. I'm seriously freaking out now...this is not the call I wanted to get at 6pm on a Friday evening...

Is this as bad as she's making it sound? Could the levels not be off because of my tfmr last year? I thought the titers weren't reliable for 2nd or later sensitized pregnancies? Please tell me there is some hope....


Hi Nonny,

Sorry to hear of the news of your high titre. There is some variation in titres from lab to lab, but these variations are minimal and if a lab has measured your titre in the thousands then it certainly is very high. Titres are one of many clinical tools used in the assessment of risk of haemolytic disease in the fetus. A high titre does indicate an increased risk, but other diagnostic tests are used to more accurately assess this later in your pregnancy.

When you are referred to the OB at the Maternal Fetal Medicine unit, they will most likely test your blood for a quantitative Anti-D. They will most likely see you after your first trimester, usually somewhere between 12-16 weeks.

I have seen a woman with an Anti-D titre of 64,000. She bought home a beautiful baby girl after a long and difficult road. The MFM specialists really know their stuff and you will be in the very best of hands. You can PM me if you ever want to chat.

QUOTE
Now i'm pregnant again and i'm 5 weeks now. Is it ok that i didnt have the Anti-D after my last m/c or not. I will be seeing my Gp next week, should i suggest to him that i have a blood test to check?


3beautifulboys-- it is within standard practice not to give Anti-D for a naturally occuring miscarriage in the first trimester. Your GP should perform a group and antibody screen as part of the standard first trimester blood tests.

#23 RealityBites

Posted 17 February 2013 - 07:59 PM

Not sure whether this is helpful but my friend was not given anti-d after her second birth and went on to have an early miscarriage with # 3. When they became pregnant again, her husband's blood was tested to see whether he could have a + or - child. They also had an amnio to make sure baby was ok. She was, thankfully.




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