Rhogam in pregnancy
Why would a pregnant RhoGAM injection be necessary?
Learn when you need the RhoGAM shot and what it means to be Rh negative during pregnancy.
The RhoGAM shot: what is it?
The RhoGAM shot, also known as anti-D immune globulin, or Rhlg, is an injection of a medication that was first made available in the 1970s. Pregnant women who are Rh negative are administered it to stop their bodies from producing antibodies against the Rh-positive blood of their unborn child.
Serious issues that could arise if these antibodies target a baby's blood cells are avoided by the vaccination.
According to Whitney Booker, M.D., an assistant professor of obstetrics and gynecology and an expert in maternal-fetal medicine at Columbia University Vagelos College of Physicians and Surgeons, where the RhoGAM shot was initially created, "all patients who have a Rh-negative blood type need a RhoGAM shot during their pregnancy."
What is the Rh factor?
The majority of people have a protein called Rh factor, which stands for rhesus factor, on the surface of their red blood cells. Either the mother or the father can pass on the Rh factor.
To ascertain your blood type and Rh status, a blood test will be performed during your initial prenatal visit. (Whether you have Rh positive or Rh negative blood, it has no effect on your health and doesn't create any symptoms.)
You are Rh positive if you do have the Rh factor, which is the case for most people. You are Rh negative if you lack the Rh factor. The percentage of Rh-negative individuals is approximately 15–17% among Caucasians (North American and European ancestry), compared to 4–8% among African Americans and 0.1–0.3% among Asians.
If you are Rh positive or Rh negative, it is determined by your blood type. For instance, "O positive" indicates that you are Rh positive, while "B negative" indicates that you are Rh negative.)
Why is being Rh negative during pregnancy a problem?
According to the American College of Obstetricians and Gynecologists (ACOG), "if you are Rh negative and your fetus is Rh positive, problems can occur during pregnancy." "Treatment can be given to prevent these problems."
The likelihood of your blood reacting with your baby's blood, which is probably Rh positive, is high if you are Rh negative. We refer to this as Rh incompatibility. Most of the time, you have to presume that your baby's blood type is positive just to be safe, but you probably won't know for sure until they are born.
During your first pregnancy, being Rh incompatible is unlikely to cause harm to either you or your unborn child. However, if your baby's blood comes into direct contact with yours (which can happen at specific points during pregnancy and, most frequently, at birth), your immune system will begin to create antibodies against the Rh-positive blood, just as it does when the body is exposed to bacteria and viruses.
Most of the blood exchange between the pregnant woman and the fetus occurs during childbirth. It takes time to produce antibodies, especially for these antibodies to reach a level high enough to possibly cause problems.
Rh sensitization is the process by which antibodies are produced in reaction to your baby's Rh-positive blood. You won't be aware that you have Rh sensitivity unless you undergo a blood test because it doesn't cause any symptoms.
The antibodies remain in your body and can cross the placenta and attack the oxygen-carrying red blood cells of your unborn child if you ever become pregnant. Mild to severe anemia is the outcome of red blood cell breakdown. While mild anemia is not a major issue, severe cases of the condition are known as Rh disease, or hemolytic disease of the fetus (HDFN), and can result in:
- Miscarriage or stillbirth
- Brain damage
- Heart failure
Fortunately, receiving the RhoGAM injection will prevent you from becoming Rh sensitive.
What time will my RhoGAM injection be?
You will receive a RhoGAM shot at 28 weeks in the third trimester if you are Rh negative. After giving delivery, you will receive another shot within 72 hours if your baby's blood tests Rh positive. You won't require the vaccination if your baby's blood tests Rh-negative. (The baby's Rh-positive blood is most likely to enter your circulation during delivery.)
Additionally, if there is a possibility that your blood has come into contact with your baby's blood, you should get a RhoGAM vaccination. A tiny amount of blood may mingle even though you and your unborn child do not share blood during pregnancy. This may occur if you possess:
- Amniocentesis
- Chorionic villus sampling (CVS)
- A miscarriage
- An abortion
- An ectopic pregnancy
- A molar pregnancy
- A stillbirth
- An external cephalic version, or ECV, is a manual technique used to turn a breech baby.
- An injury to your abdomen during pregnancy
- Vaginal bleeding
- Placental abruption
- A blood transfusion
Remind your carer that you are Rh negative and ensure that you have the vaccination within 72 hours if you find yourself in any of these circumstances.
Because the shot only lasts for 12 weeks, you will require more shots each time you become pregnant.
If your body has already begun producing antibodies, the RhoGAM shot will not be effective. In this scenario, your unborn child will be closely watched for any possible issues during pregnancy.
What is the process of the RhoGAM shot?
Blood donors provide a tiny dosage of antibodies for the Rh immunoglobulin (Rhlg) injection. Your immune system appears to be prevented from producing its own antibodies by these antibodies, which destroy any Rh-positive blood cells in your body. Although the dose of the donated antibodies isn't high enough to harm your unborn child, they are identical to yours.
This is known as passive immunization, and in order for it to be effective, you must receive the shot no later than 72 hours following any possible contact with your infant's blood. You may require a second shot if your doctor believes that more than a gram of your baby's blood may have mingled with your own, such as in the event of an accident. If required, specific blood tests can be performed to determine the precise amount of fetal blood that has mingled with your own.
The injection will be administered to your arm or buttock muscles. You can feel a small fever or some discomfort where the injection was made. No more adverse effects are known to exist. The injection doesn't hurt your unborn child or pass the placenta. And whether or not your baby's blood is Rh positive, it's safe.
What if I had a prior pregnancy and had not received a RhoGAM shot?
A standard prenatal blood test can determine whether you already have the antibodies that target Rh positive blood and how many antibodies have been produced if you are Rh negative and have previously been pregnant without receiving the RhoGAM shot. (You might have them even if you had an ectopic pregnancy, an abortion, or a miscarriage.)
It's too late to receive the RhoGAM vaccination if you do have the antibodies. Throughout your pregnancy, your doctor will plan to monitor you and your unborn child with blood testing and, if necessary, specific ultrasound tests to identify fetal anemia. For advice or treatment, you can be sent to a maternal-fetal medicine specialist.
These days, there are precise, non-invasive methods for monitoring a fetus that may be at risk for anemia. The majority of at-risk fetuses do not develop anemia severe enough to need medical attention. Fortunately, there is treatment available if they do.
Throughout pregnancy, your healthcare provider can track your antibody levels and your unborn child's health to see whether the disease is spreading to them. They might use amniocentesis or Doppler ultrasound to assess the health of your baby's red blood cells.
According to The March of Dimes, newborns can receive a blood transfusion as early as 18 weeks of pregnancy if needed. It is necessary to birth some newborns with Rh illness early. However, you might be able to carry your pregnancy to term without any issues if your unborn child is doing well.
Your kid will receive treatment to avoid more difficulties if they are born with anemia. If the condition is severe, your newborn can need a transfusion to replace the damaged red blood cells with healthy ones.
