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Re: Rhogam injection during Pregnancy-Dr. MFrom: Christine (anonymous@obgyn.net)Mon, 22 Nov 1999 07:51:30 -0600 (CST)
At Sun, 21 Nov 1999, Harvey S. Marchbein, M.D. wrote: > >At Sun, 21 Nov 1999, Christine wrote: >> >>Hi! >> >>I just read the post about RH incompatibility and miscarriage and I >>realized that they must now be giving Rhogam during pregnancy (to RH >>negative mothers) as well as after delivery of an RH positive infant to >>an RH negative woman (and also miscarriage in an RH negative woman) I >>can see where they could not risk sensitization from miscarriage, but is >>the chance of sensitization during pregnancy a great enough risk to >>justify using Rhogam when the blood type of the fetus is unknown? > >Absolutely. A Canadian study several years ago showed a 1-2% >sensitization rate when RhoGam was given only after delivery. Adding >the shot between 28 and 32 weeks drops this to near zero. You just have >to see one sensitized pregnancy and the amazing and heroic efforts >necessary to save such a pregnancy (not to mention the emotional and >financial toll on the family) to see the worth in an "extra" shot. Worth >it's weight in gold? And there's no down side. If the baby's Rh >negative, no harm. > >>Another question-the person who posted mentioned that her husband was RH >>positive. Would this actually matter when giving Rhogam during >>pregnancy? In other words, would they assume that if the husband (who >>may not necessarily be the father) was RH negative, then no Rhogam would >>be necessary during pregnancy? > >Another can of worms and your point is well taken. I presume that a >ptient won't lie to me about the paternity issue and so far, I haven't >been disappointed (to my knowledge). Haven't had any sensitized babies >yet. Thank G-d. > >-- >Harvey S. Marchbein, M.D. FACOG, FACS >Great Neck, New York > >**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 emails cannot be entertained due to time constraints, >consequently no private emails will receive a response. > >**Thank you for your understanding ;-) Hi! Thanks for your response, Dr. M. I wasn't criticizing the use of Rhogam during pregnancy. I'm always amazed at how protocols change. When I was having babies (1979 and 1981) this was not done routinely, but I think they were starting to talk about it but then not too many years before me Rhogam wasn't even an option! I realize that you are depending on a patient being honest with you, but there are situations-denial etc. where the patient might not even realize she is lying. Or where the risk of being honest too great (of course the patient may not realize by not being honest that the risk to the baby could be even greater.) Rather than take this risk, or risk offending the patient by auggesting that her husband might not be the father, I wondered if it would be acceptable to go ahead and give Rhogam to all RH negative women unless proven (as in baby' blood type) that it is not necessary. I guess the same would apply to an RH negative woman having a miscarriage and has an RH negative husband. I'm not expecting an answer on this, just wondering. Chris S.
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