PREGNANCY-BIRTH Messages for February, 2001: Re: Looking for input on Rh disease/antibody titer values

Re: Looking for input on Rh disease/antibody titer values

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 28 Feb 2001 18:57:45 -0600 (CST)

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In reply to: Catherine: "Looking for input on Rh disease/antibody titer values"

At Wed, 28 Feb 2001, Catherine wrote: >
>I am 25 wks pregnant with my third child. I am Rh negative and have
>received Rhogam at 28 wks and after birth with my 2 previous
>pregnancies, but somehow I became sensitized after my last pregnancy. My
>titers were 1:8 for anti-c and 1:16 for anti-D at 11 wks gestation. At
>22 wks gestation they were 1:8 for anti-c and 1:32 for anti-D. My
>doctor does not seem to be concerned with the numbers at this point. I
>have found many articles on the subject on the web and although they
>vary in what they call the "critical" titer, it seems to me that I
>should at least be referred to a perinatologist at this point for a
>consultation. Some of the articles I found quoted a titer of 1:16 for
>anti-D as a point where amniocentesis would be the next step, others
>used 1:32. Currently, I am scheduled for another blood draw at 28 wks,
>along with an ultrasound. Is this time frame too long? After all the
>research I did, I called and talked to my doctor about my concerns and
>he told me he would call and talk to a perinatologist about my case, but
>I haven't heard back from him. Should we be treating this more
>aggressively? I'm very concerned that I don't know the condition of my
>baby - from what I've read, there are no other reliable tests to
>determine the fetus' condition except for amniocentesis and
>cordocentesis. I certainly don't want to have invasive testing done if
>it isn't necessary, but I believe that in my case, it IS necessary. Any
>input you can give me would be greatly appreciated. Thank you for your
>time!

You are absolutely correct. The critical titer for D is 16. Your baby should be evaluated, either by amniocentesis or doppler ultrasound evaluation of the middle cerebral artery velocity (which ever is available in your area). This needs to be done every week to two, starting at 18-20 weeks of the pregnancy. To allow you to continue without evaluation, until 28 weeks risks missing a major problem... Lynn P.S. I am a perinatologist

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana

**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.

**Thank you for your understanding ;-)

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