PREGNANCY-BIRTH Messages for August, 2000: Re: PPHN & RH disease link?

Re: PPHN & RH disease link?

From: Amanda

anonymous@obgyn.net

Fri, 11 Aug 2000 00:15:56 -0500 (CDT)

I was told by my OB that if the levels at the June 30th amnio were low enough that we wouldn't have to do any further amnio testing. That amnio was my fourth. With the first one, the Delta OD levels were upper Zone 1. The second amnio showed the levels to remain flat, however, since I was farther along in the pregnancy, that put me in lower Zone 2. The third amnio showed the levels had dropped back into upper Zone 1, and then the last one showed the level had dropped even more into Zone 1. My OB had said before the fourth amino that if the levels dropped low enough, then we wouldn't need a repeat amnio for the rest of the pregnancy. Starting with week 36 I had 2x weekly NSTs and 1 BPP per week until it was decided to induce labor.

In speaking with another OB at the practice, he said that the testing in utero only guarantees that the baby isn't going to die before delivery...it was doing well inside the womb...but they can't predict what problems may occur after delivery. The doctors did mention after he was born that he had low hemoglobin counts and a lot of immature red blood cells. I'm not sure if delivering earlier than 37w5d would have helped or not...I wouldn't want his lungs to be underdeveloped. From what I understand, his lungs are fine now, they just didn't convert from being in the womb to functioning correctly outside (the arteries opening up after birth). I had asked my OB about inducing earlier than 37 weeks, but he said that Gestational Diabetics' babies often have slow lung maturity and since the testing showed the baby to be okay, they wanted to give it a few more days at least.

One other note is that there is currently a bit of confusion about the RH factor in our son's blood. The doctors say that his blood tests came back showing him to be A- (same as I am), but if that is the case, then the anti-D wouldn't have been a factor in his anemia at all. It would have to have been all anti-C, which actually had much lower titer levels in my blood than anti-D. One of the neonatologists did mention that the blood test could be inaccurate if a lot of my antibodies were "coating" his blood cells causing a false negative reading. I think that we're going to have to wait until the antibodies work their way out of his system and retest for his type then. I personally think that he's A+, because he's having such problems with high billi levels now. It is a very confusing subject, especially with the rarity of RH disease.

-Amanda

At Thu, 10 Aug 2000, Lynn D. Montgomery, MD wrote: >
>At Thu, 10 Aug 2000, Amanda wrote:
>>
>>Hi all,
>>
>>I just had a baby via unscheduled c-section at 37w5d on Aug 4. He is
>>doing much better now, but at the beginning, we didn't know if he would
>>make it. He was diagnosed with Persistent Pulmonary Hypertension, and
>>put on the ECMO heart/lung bypass machine for 3 days. He also received
>>2 exchange transfusions. His indirect billirubin levels are low enough
>>that they don't have him on the lights, but his direct billi levels are
>>still a bit high and they have him on Phenobarbitol (not sure if that's
>>the correct spelling) to help his liver process the billirubin.
>>
>>I was diagnosed Rh sensitized to both C & D antibodies during pregnancy.
>>My OB and I were a little surprised to find out he is having such
>>problems with the anemia, since his last amnio showed the Delta OD
>>levels to be in Zone 1 on June 30th. Ultrasound showed no effects of
>>anemia.
>>
>>Can the PPHN be linked to the Rh problem, or is it more likely a
>>seperate issue altogether. My husband read that instances where there
>>is a low oxygen level in the blood already (as was the case with my
>>son), then the arteries in the lungs won't open up after childbirth.
>>
>>Thanks for your help!
>>
>>--
>>Amanda
>>
>Amanda,
>Your observation is certainly astute, unfortunately there is little
>known about the cause of PPHN. There could be a relationship with the
>degree of fetal anemia in your baby, however PPHN is not a universally
>observed complication of anemic babies seem following Rh sensitization.
>The question that comes to mind when reading your history is why did you
>have your last amnio in June and not deliver until August? What about
>the fetal surveillance relative to the antibodies in July? That's quite
>a while to wait before either doing another amnio or delivering...
>Lynn

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