RhoGam question

nursecave · Mar 22, 2007

just correct me or enhance my understanding
about when RhoGAM is given.
If the mother is Rh negative and unsensitized
then she receives RhoGAM if she has an Rh positive fetus,
but she does not receive it if the infant is negative.
She might have received antibodies as a fetus from her own mother if her mother was Rh positive, so she might already be sensitized before becoming pregnant herself.
Her Rh status must be tested first using indirect Coombs' test.
If she has a miscarriage, elective abortion, ectopic pregnancy or molar pregnancy, then a microdose of immune globulin is used within the first 12 weeks' gestation. So, is she routinely given the RhoGAM after these events, if she is tested and found unsensitized (after first being tested to determine if she is already sensitized)?
thanks

I might be wrong, but I think they give it anyway as a precaution. I work postpartum and we give it almost always. Every now and then we have someone who blood bank deems ineligible for RHOGHAM but not often.

beckinben, CNM · Mar 22, 2007

I might be wrong, but I think they give it anyway as a precaution. I work postpartum and we give it almost always. Every now and then we have someone who blood bank deems ineligible for RHOGHAM but not often.

You give it to women who have Rh negative babies? Or are those the ones deemed ineligible? If you do give it to Rh - women with Rh - babies, why? It's expensive stuff to give to people who don't need it.

Almabella · Mar 22, 2007

just correct me or enhance my understanding
about when RhoGAM is given.
If the mother is Rh negative and unsensitized
then she receives RhoGAM if she has an Rh positive fetus,
but she does not receive it if the infant is negative.
She might have received antibodies as a fetus from her own mother if her mother was Rh positive, so she might already be sensitized before becoming pregnant herself.
Her Rh status must be tested first using indirect Coombs' test.
If she has a miscarriage, elective abortion, ectopic pregnancy or molar pregnancy, then a microdose of immune globulin is used within the first 12 weeks' gestation. So, is she routinely given the RhoGAM after these events, if she is tested and found unsensitized (after first being tested to determine if she is already sensitized)?
In our office it is routinely given to ALL Rh- pregnant pts at 28 weeks, after delivery and in all of the above mentioned situations. We will give it to all women with Rh neg blood type as we do not know what the baby's blood type will be (especially of the father is NOT Rh -, but we do not test dad's blood or take his word for it; we just give it to all women who are Rh-).
Hope that helps!

nursecave · Mar 22, 2007

No. Not the ones with Rh- babies. They are ineligible. I meant every now and then somebody who has an Rh + baby will be deemed ineligible. I haven't had that happen but once in 6 years, but it has happened. Thanks for pointing out that I wasn't too clear with my response. Kinda unrelated, but I always hate when Blood bank calls and says the mom need 4 Rhoghams. Explain that to the poor PP mom!

GingerSue · Mar 22, 2007

thanks

are they testing first though, before giving the RhoGAM, to be certain that these women are unsensitized?

(because if she is Rh negative who received her own mother's antibodies while she was a fetus,{if her mother was Rh positive}, then she might be sensitized already, or if she received a mismatched blood transfusion, and then the RhoGAM is not effective)

testing first, whether at 28 weeks', or after ectopic, molar, or abortion?

SmilingBluEyes · Mar 22, 2007

A really good article from Web MD that discusses Rh sensitivity and RhoGAM use in and after pregnancy and rationales:

http://www.webmd.com/content/article/4/1680_51841?src=Inktomi&condition=Health%20Topics%20A-Z

Overview

Most people have heard of the terms "Rh positive" and "Rh negative" in discussions regarding blood type. Many people are aware of their particular blood type, such as A-positive or O-negative. General blood types exist in many different combinations as well as in less common combinations with less common blood cell characteristics. None are better or worse than another, they are simply different.

Much more detail is given as to when RhoGAM is used in pregnancy and postpartally and why. Check it out.

SmilingBluEyes · Mar 22, 2007

With all our doctors, RhoGAM is given as a matter of routine, not after testing, in pregnancy. And if a baby born is RH neg, then the mom receives NO RhoGAM after delivery. The above article is a good one.

GingerSue · Mar 22, 2007

thanks, I'll look at the article

this is what it says about lab work:

"Also, the prenatal lab work will be drawn early in your prenatal care. It may also be necessary to test for the father's blood type and Rh status. If this is your first pregnancy with this man, and he is also Rh negative, there is no reason for concern because the baby will also be Rh negative like his parents. Even if the father is positive, there is still a chance that you and he could conceive an Rh negative child, again eliminating any concern for the baby's health due to Rh disease.

If you are already known to be Rh sensitized, your antibody screen will be positive. The laboratory will specifically identify the antibody and then measure the amount of antibody present in your system. This measure, or titer, determines how early to begin watching and/or treating the baby for problems. The higher the titer, the sooner the baby will begin to have symptoms of hemolytic disease and the sooner it will require intervention."

Elvish, BSN, DNP, RN, NP · Mar 22, 2007

Where I am, everybody that's Rh neg gets it at 28weeks regardless. After delivery, if babe is Rh pos then Mom has to get it within 72hrs.

GingerSue · Mar 22, 2007

but is their lab work being done to determine if they are already sensitized {because if they are already sensitized, then the RhoGAM is ineffective}?

RunnerRN, BSN, RN · Mar 23, 2007

Just wanted to jump in to give you the ER perspective. We give any miscarried mom who is rH- RhoGAM. If they are + they don't get it. We only do miscarriages under 20 weeks; if someone is over 20 weeks, they go to L&D. We do not do any testing.