[*~~Jess~~*]

After the birth of DD2 I developed an amniotic fluid embolism and also diagnosed with anti e antibodies.

It was discovered that I still have the antibodies when I had bloods done for this pregnancy. I have spoken to my OB and the chance of another embolism occurring is low but I will need to see the high risk clinic because of the antibodies and the risk to my baby because of them.

Has anyone else had an amiotic fluid and not had another one in your next pregnancy?

Also has anyone had anti e antibodies, did your baby have any side effects at birth because of it?

[kwiggle]

Congrats on your pregnancy Jess - I reckon you'll be pretty bored of hospitals and doctors by the end of this one!
The most likely thing is that your pregnancy will be boring, but they will take lots of blood tests to make sure your antibody levels remain stable, and if they go up will do lots of ultrasounds to check whether your baby is becoming anaemic. Worst case scenario (and pretty rare) is that your baby would need blood transfusions in utero.
In terms of the amniotic fluid embolism.... noone will be able to tell you what the risk of recurrence is reliably because it's so rare. My best guess is that it's unlikely to happen again.
You're a brave lady - are you coping with the idea of being pregnant again? I hope you don't have too many scary thoughts.... I don't have any personal experience with those issues, but wanted to reply because I can imagine it's going to be a stressful time for you. Good luck!

[katpaws]

Hi Jess

I had an AFE 10 years ago but have been diagnosed with secondary infertility so no second baby. I had decided to go for a CS (elective) if i got pregnant again - the AFE occured during an attempted vaginal birth.

I understand that the chance of another AFE occuring in subsequent pregnancies is very very low. However, my OB did advise having an CS and avoiding labour with another baby, however my AFE was pretty bad so this may affect medical advice given.

I would recommend that for your next pregnancy you have an OB you have a high level of trust in and in the health professionals supporting you. If you suffer from PTSD you need to advice your medical team, also be aware that flashbacks to the AFE could occur so have a management plan for that. I would advise having someone with you during your labour or CS (whichever way you go) and not being left alone, even for a few minutes, so someone is always monitoring you.

When you book your hospital ask them about their AFE management plan ie do they gave the cogulation products needed on hand? Do they have an intensive care ward in case things go wrong?

AFE is on the suckiest worst things that can happen to you. The fact that it is not predictable and can't be tested for just makes it such a horrible thing.

Best of luck with everything

[deejie]

Also has anyone had anti e antibodies, did your baby have any side effects at birth because of it?

Anti-e (lower case) is a different antibody to Anti-E (uppercase). I'm not sure if you meant the lower case "e" or not, so will cover both.

Anti-E can sometimes be naturally occuring. The naturally occuring Anti-E antibodies are usually low titre and of little clinical concern. Immune Anti-E which were stimulated by previous pregnancy/transfusion are usually associated with mild -> moderate effects in the developing fetus. Severe fetal anaemia from Anti-E antibodies is uncommon.

Anti-e antibodies are very rarely naturally occuring and are usually the result of previous pregnancy/transfusion. They are typically associated with mild -> moderate effects in the developing fetus and like Anti-E, severe fetal anaemia is uncommon.

Your partner will be tested for the E/e antigen. If he is heterozygous (one copy of the gene), your baby will have a 50/50 inheriting it and being at risk. If he is homozygous (two copies of the gene), your baby will definitely carry the E/e antigen and will be at risk.

I'm sure you will be sick of ultrasounds and tests by the time your pregnancy is done!
Most antibodies are still quantitated in the laboratory by a test called the antibody titre which is performed on a sample of your blood. This gives a rough estimate of the "level" (for lack of a better word) of antibody in your blood. The higher the titre, the higher the level of antibody and (generally speaking) the higher risk involved for your baby. In some pregnancies, the titre remains stable throughout. In other pregnancies, it can go up a little or a lot.

There are ways of typing the baby for the E/e antigen before it is born. It can be done via amniocentesis and extracting fetal DNA from a sample of amniotic fluid. Amnio obviously carries risks. Fetal e/E antigen typing can also be done on a sample of maternal blood from the second trimester. Fetal DNA can be extracted and typed. These tests are usually done when the maternal antibody is one of the "nasty" ones (D, K, c), the titre is very high the baby is considered at high risk. It is rarely done in the case of Anti-E/e. Otherwise, monitoring tests will show whether the baby is affected.

If your titre is high, your OB team will monitor the health and wellbeing of your baby by MCA (middle cerebral artery) ultrasound. They measure the velocity (speed) of the blood in the middle cerebral artery in your baby's brain. If you have lots of antibody crossing the placenta and destroying your babies red blood cells, your baby will be anaemic. Its heart will beat faster to pump a smaller volume of red blood cells around its body and therefore the velocity of the blood increases. The velocity of the blood is a good indicator of how anaemic your baby is and the treatment it needs (further monitoring, early delivery, transfusion still in the womb in very severe cases).

Babies used to be monitored by looking at the bilirubin levels (a red blood cell breakdown product) in the amniotic fluid. This was done by amniocentesis, but this is not done very often these days due to the risks associated with amnio vs the non-invasive MCA ultrasound.

Intra-uterine transfusion in cases of Anti-E/e is rare. Most babies are born closer to term. Rarely (in cases of very high titres) they will require an exchange transfusion soon after birth. This removes the maternal antibody from their system and replaces their own "E" or "e" type red blood cells with cells from a donor which are compatible with the maternal antibody. Most babies born to Mums with Anti-E/e and moderate to high titres will have jaundice and will have treatment under the UV lights (similar to other babies who have jaundice for other reasons).

While it does sound scary, the OBs at the maternal fetal medicine unit that you will be attending really are the experts at handling immunised pregnancies. Don't be afraid to pepper them with a thousand questions. You will be in the best of hands.

edit- to make more sense (I think)

This post has been edited by deejie: 06/03/2013, 09:04 PM