RhoGAM Improperly Administered

I am Rh-negative but my husband and baby are Rh-positive. My doctor did not give me RhoGAM until 96 hours after birth. I want to have another child, but will not try if I have been sensitized. My doctor said that I could not be tested for sensitization for six months because the RhoGAM would mask antibodies. Can I be tested earlier?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

How tragic! Where was everyone? Excuse my indignation, but this was really preventable.

RhoGAM administered that late really has no effect, as the antibodies begin to develop soon after birth. But your doctor is correct that after you receive it, you must wait about six months to detect antibodies. It would not have been reasonable to test for antibodies before you were given the late RhoGAM because it is with the next pregnancy that your body will produce the most antibodies. Memory cells are present which seem to "remember" the past insult and, with subsequent pregnancies, produce greater numbers of antibodies against the current pregnancy. Antibody titers can be drawn, but they may not be very pertinent unless they are very high for some reason. If they are low, that does not tell us how they will respond with the next pregnancy.

With the next pregnancy, titers will be followed very carefully and any increase over 1:16 is considered "critical" and indicates that the baby will be seriously affected and perhaps die if intervention is not started. Amniocentesis, sampling of the fetal blood through the umbilical cord, multiple ultrasound evaluations and, in some cases, intrauterine blood transfusions, will improve your chances of delivering a baby who is minimally affected.

Not all fetuses are affected anyway. There may have been no significant mixing of your bloods or your response may have been a weak one. There is really no way of knowing until you can see what a future pregnancy will do to your titers. You should have received a dose of RhoGAM at about 28 weeks gestation as well, which may have protected you despite the lack of the postpartum dose.

I would consult a perinatologist before your next conception to get his or her advice regarding this. An antibody titer can be done at any blood bank and is done routinely when you give blood. Those records can be released to you or to your physician at your request.

I hope that you can come to resolution about this and also hope this has changed the way your physician now practices, so this will not happen again.

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