Re: Rhogam
From: art fougner, md (evsono@pipeline.com)
Mon May 12 08:20:16 2003
well this is what passes for evidence on this topic -
Am J Obstet Gynecol 2003 Mar;188(3):623-7
Is Rh immune globulin needed in early first-trimester abortion? A
review.
Jabara S, Barnhart KT.
Department of Obstetrics and Gynecology, University of Pennsylvania,
Philadelphia 19104, USA.
The prophylactic use of Rh immune globulin has been a medical success,
protecting women who could be at risk from exposure to the Rh(D)
antigen. Thus,
it is not surprising that Rh(D) immunoprophylaxis has been extended from
women
with term pregnancies to all women with miscarriages, abortions, and
ectopic
pregnancies. In this article we review the existing medical literature
to assess
the risks of fetomaternal hemorrhage and Rh isoimmunization after
complications
of a first-trimester pregnancy, induced abortion, or ectopic pregnancy.
The
evidence to support the use of Rh immune globulin in the first trimester
is
sparse, but there is theoretic evidence of its necessity. Despite weak
evidence
to support its use, there is little risk.
art
At Mon, 12 May 2003, Richard Chudacoff, MD wrote:
>
>My thoughts exactly: she passed a sac, and the remaining tissue was at best
>some clot and remnant membranes, which I am not aware of having Rh antigens.
>If there had been a sac remaining, with an embryo, then I could understand
>the idea of the injection, but where is the physical evidence that
>spontaneous abortions, without evidence of remaining embryo could lead to
>sensitization?
>
>--
>Richard Chudacoff, MD, FACOG
>
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>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Griffiths
>Malcolm (RC9) Luton & Dunstable Hospital TR
>Sent: Monday, May 12, 2003 7:45 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Rhogam
>
>No I am unaware of any evidence, but guidelines aren't always based on
>evidence! I think the theoretical idea is that any cells expressing the
>antigen might be more likely to enter maternal circulation in relation to
>the trauma of curettage. The fact that no such cells expressing the antigen
>will be present seems to have been overlooked!
>
> -----Original Message-----
>From: evsono@pipeline.com [mailto:evsono@pipeline.com]
>Sent: 09 May 2003 18:56
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Rhogam
>
>Malcolm
>
>is there any evidence that completion of a spontaneous miscarrage by
>curettage results in a higher risk of sensitization than spontaneous
>completion?
>
>just wondering the basis of the recommendation.
>
>art
>
>At Fri, 9 May 2003, Griffiths Malcolm wrote:
>>
>>I think your approach is scientifically correct. There is no expression of
>>Rhesus antigen at very early gestations. However guideline in UK advises
>>anti-D if miscarriage involves surgical evacuation.
>>
>>-----Original Message-----
>>From: Richard Chudacoff, MD [mailto:rchudacoff@mylinuxisp.com]
>>Sent: 09 May 2003 17:18
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Rhogam
>>
>>Patient had an early first trimester spontaneous abortion, then came to see
>>me a week later with bleeding. There seemed to be some retained POC, so I
>>did a D&C on her. The pathologist called and asked why, if she is Rh
>>negative, I did not give her Rhogam, and I told her that the risk of fetal
>>transmission would be too low to require it. Am I way off base?
>>
>>--
>>Richard Chudacoff, MD, FACOG
>>Chudacoff Obstetrics & Gynecology, PLLC
>>15200 Southwest Freeway, #270
>>Sugar Land, TX 77478
>>
>>Tel: 281-277-3900
>>Fax: 281-277-3901
>>
>>rchudacoff@mylinuxisp.com
>>Richard.Chudacoff@obgyn.net
>>
>>http://www.mdhub.com/281-277-3900
>>http://www.chudacoffobgyn.yourmd.com
>>
>>*****HIPAA Confidentiality Notice*****
>>
>>The documents inside this electronic transmission contain confidential
>>information belonging to the sender that is legally privileged. This
>>information is intended only for the use of the individual or entity named
>>above. The authorized recipient of this information is prohibited from
>>disclosing this information to any other party and is required to destroy
>>the information after its stated need has been fulfilled, unless otherwise
>>required by law.
>>
>>If you are not the intended recipient, you are hereby notified that any
>>disclosure, copying, distribution, or action taken in reliance on the
>>contents of these documents is strictly prohibited. If you received this
>>electronic transmission in error, please notify the sender immediately to
>>arrange for return.
>>
>--
>art fougner, md
>ich bin ein New Yorker
>
--
art fougner, md
ich bin ein New Yorker
