Download Client Information About Rhogam During and After Pregnancy

Client Information About Rhogam During and After Pregnancy
What is the Rh factor in a blood type?
Blood types are grouped as O, A, B, or AB and as either “positive” or “negative” for the Rh factor. When a person’s
blood is positive (+) for the Rh factor, the blood cells have an antigen (a type of protein) on the outside of each cell.
When a person’s blood is negative (-) for the Rh factor, the blood cells do not have this antigen on the outside of each
cell. The potential problems described below do not happen in women who are Rh+, regardless of the baby’s blood
type.
Why is the Rh factor important during pregnancy and postpartum?
If a woman with Rh- blood receives any Rh+ blood in her system, her immune response makes antibodies to remove
the foreign Rh+ antigens. The immune system thinks that these antigens are invaders, like bacteria or viruses.
Unfortunately, this immune response destroys the whole red blood cell in the attempt to destroy the antigen on the
surface of the red blood cell. Once the body has completed this immune response one time, it retains a memory of
how to complete this process. If Rh+ red blood cells enter the body on another occasion, the antibodies can be
produced very quickly and in great numbers to destroy all Rh+ blood cells. It does not usually hurt the woman to be
Rh factor sensitized. Her blood can be checked for sensitization by sending a blood sample to the lab for an Antibody
Screen Test.
The immune system response described above can happen during pregnancy if an Rh- woman has an Rh+ baby in her
womb. Usually in pregnancy and birth, blood of the fetus does not mix with or come into contact with the mother’s
circulation. If, for some reason such as trauma, ectopic pregnancy, spotting, bleeding or placental issues, any of the
baby’s Rh+ blood cells get into the mother’s Rh-circulation, she will make antibodies to fight the Rh+ blood cells in her
body. It is possible that eventually the antibodies from the mother’s immune system will cross the placenta and begin
to destroy the baby’s blood cells or it may happen in future pregnancies if those babies are Rh+. This destruction
process can create anemia, an enlarged liver and spleen, and swelling in the baby. If too many red blood cells are
destroyed, the baby may die. The medical name for this is Hemolytic Disease of the Newborn (HDN).
It typically requires two exposures to the Rh antigen for any significant destructive response, except for an initial
massive exposure when there is a great deal of positive blood entering the mother’s Rh- circulation. The first pregnancy
in which the mom is Rh- and baby is Rh+ and the blood mixes is usually healthy without a destructive response. It is
often the following Rh+ baby that may suffer ill effects.
What is Rhogam and what does it do?
RhoGam, WinRho, HyperRHO, and BayRho are three brands of Anti-D designed to prevent antibodies to the Rh
factor from forming in the mother. These products are similar in nature and vary in cost, and RhoGam ~ contained
mercury while the other three have not. Rhogam is the trade name for Rh immune globulin, a substance produced from
human blood, which is carefully screened and then processed to eliminate all substances (like Hepatitis and HIV) except
the Rh component. This active substance is then injected into pregnant women who have an Rh- blood type. When an
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Rh- woman is pregnant, no one knows the baby’s blood type until after the baby is born. The midwife must assume
that the baby might be Rh+. The only exception to this is if the biological father of the baby is Rh- like the mother. In
this case, the baby will be Rh- and the immune response described above will not occur.
Rhogam can be given to a Rh- pregnant woman to prevent her body’s immune system from being stimulated if any of
the assumed Rh+ blood enters her circulation. This can happen anytime during pregnancy but is more common in the
third trimester, at birth or if some trauma occurs. The mixing of maternal and fetal blood is sometimes not noticeable.
The Rhogam destroys the baby’s blood cells that have entered mom’s blood system before the mom’s system can
recognize them. This way, the mom’s system does not store a memory of the Rh+ antigen and she does not become
“sensitized”. Rhogam does not destroy the baby’s blood cells while in the womb. Rhogam only attacks the Rh+ blood
cells that enter the mom’s circulation.
Accepting Rhogam after a birth alone reduces the risk of sensitization from 13% to 2%. Giving Rhogam twice, at 28
weeks gestation and after the birth reduces the risk of sensitization to 0.2%. If an Rh- woman has become severely
sensitized to the Rh factor, giving her the Rhogam will not help. How own body’s immune response will be so strong
that it will disregard the Rhogam.
When is Rhogam usually given?
Rhogam is offered to all Rh- women:
1. When they are 28 weeks pregnant. The effects of Rhogam last approximately 3 months (12 weeks) which
is approximately when the baby will be born. Rhogam is not offered to pregnant women earlier in
pregnancy unless there is a specific reason.
2. Within 3 days after the birth if the baby has Rh+ blood, in case some of the baby’s blood got into the
mother’s blood system during the birthing process. The midwife will send a sample of the baby’s blood
taken from the umbilical cord to the lab to determine baby’s blood group and Rh type.
3. After a miscarriage or abortion.
4. After an amniocentesis or chorionic villus sampling (CVS).
5. After any kind of trauma such as a car accident or fall.
6. For any potential problem where the midwife thinks that the baby’s blood cells may have been released
into the mom’s circulation, such as some sort of bleeding coming from the cervix, vagina, and uterus or
during an external version.
What are the risks of Rhogam?
As with any injection, there may be pain or soreness at the injection site. As with any medication, the possibility of an
allergic reaction exists, although an allergic reaction is extremely rare. The midwife will wait 20 to 30 minutes with you
after the Rhogam injection to ensure that you are OK. Be sure to tell your midwife if you have ever had a serious
allergic reaction to medication, especially if it was Rhogam.
Rhogam is prepared from donated blood, but the risk of transmitting a disease such as hepatitis or HIV is very small
because of the extensive screening and preparation of the blood cells.
One injection of Rhogam may not be effective if the number of baby’s cells in the mom’s system is too many for
Rhogam to manage. In these rare cases, more than one dose of Rhogam can be indicated.
Rhogam administered during pregnancy appears to have no adverse effects on the fetus. However, sufficient long term
studies have not yet been done. The blood of babies born to women who have had Rhogam show a mild antibody
response.
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Informed Consent/Informed Declination for Administration of Rhogam
I, _____________________________, have read the information and have had the opportunity to
ask questions. I understand the risks and benefits of receiving or not receiving Rhogam. My choice(s) are
initialed below:
_____ I choose to have Rhogam/HyperRHO :
_____ Only after the baby’s birth if the baby is Rh+
_____ At approx. 28 weeks and after the birth if the baby is Rh+
_____ Earlier in pregnancy if there is a medical indication
_____ I decline to have Rhogam/HyperRHO .
_____ My baby’s biological father is Rh-.
_____ I am declining Rhogam/HyperRHO for my own reasons:
If I change my mind or wish to talk about Rhogam/HyperRHO further, I will tell my midwife.
______________________________________________
Client
_____________________
Date
______________________________________________
Midwife
_____________________
Date
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