[nonny1]

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

[tibs]

Sorry for your loss 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 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

[Girlo]

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.

[Corella]

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.

[tibs]

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.

[Natttmumm]

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??

[Mousky]

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.

[tibs]

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.

[deejie]

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

[nonny1]

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.