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Re: RhogamFrom: Ira Mark Bernstein (ibernste@zoo.uvm.edu)Mon Jun 30 08:40:15 1997
>Question: > >20yo, G4 P2012. Rh neg. NSVD x 2 with rhogam after del. TAB @ 20 wks >without rhogam. Presents for first prenatal visit. No dates. FH is 36 cm. > UTZ today 34w5d. Antibody screen neg. > >Would you give rhogam today? Why or why not? Yes, I would because you are trying to protect against prenatal sensitization of the mother. The dose you give today will protect throught delivery. Just becuase you have missed out on protecting the pregnancy from 28-34 weeks is no reason not to provide protection from 34 weeks through delivery.
>She delivers 4 weeks later. NSVD. Baby is Rh positive.> Original stuidies suggested an efficacy of 330 micrograms of Rh-D through 12 weeks, more recently Witter has demonstrated that the serum is generally clear of rhogham after 6 weeks. But the real answer is that as the serum level drops the protection level drops. At the time of dosing there is protection for a 30 cc fetal to maternal hemorrhage. As time goes on the volume of protection diminishes. Four weeks after delivery the absolute level of protection is uncertain. A large fetal-maternal hemorrhage may provoke sensitization but this would seem unlikely after an uncomplicated NSVD. Before deciding on a repeat dose I would check a maternal antibody screen and a Kleihauer. If the antibody screen is positive for RhD (from the Rhogham) and the Kleihauer is negative or only rarely positive I would not add a second dose. In most other circumstance I would err on the side of too much rather than too little and give an additional dose.
>I've presented this to the MDs at work and have gotten come conflicting IRA
-- Ira M. Bernstein M.D. Department of OB\GYN University of Vermont (802) 656-5111 (ph) ibernste@zoo.uvm.edu
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