Anti-D during pregnancy

[Freddiecat]

My blood group is O negative and when my first baby was born I was given the Anti-D plasma injection. I thought this was to prevent me from producing antibodies which might cause me to reject a second pregnancy.

I am now told that the new thinking is to give pregnant women who are O negative injections of Anti-D twice during pregnancy as well as after the birth. Apparently they now believe that I could produce antibodies which may affect the baby I am carrying. My midwife commented that the late miscarriage rate has dropped since they started doing this (last summer).

I am slightly confused. I obviously want to do what is right by my baby but there are (tiny) risks of infection with blood products. Can anyone point me to anthing which could explain all this to me in some more detail?

[momof2]

Freddiecat,
I too am negative and DD was positive when she was born so they gave me the injection just after. I was told that there was more danger in the second pregnancy to me, if the baby was positive rather than to the baby and I would ahve to be monitored more closely.
I am googling at the moment and will see if I can find anything
Mof2

[hewlettsdaughter]

Hi Freddiecat, don't know if this helpful but I am O neg and in my second pregnancy. I had anti-D during my first pregnancy and have been told it's not policy to give it second time round.

[Freddiecat]

Oh! I've been told something about "sensitising events" during pregnancy, some of which I might not be aware of where my blood could cross the placenta and cause somethingsomething disease of the newborn which kills 30 babies a year or something like that. I am being given Anti-D at 28 and 34 weeks (am 23 weeks right now).

[momof2]

FC - have a look at this
I have to admit I had no idea of this issue at all. My DD2 is my step daughter so I have only had one pregnancy (so far - trying at the moment)
Haven't read it all through yet, so don't know if it answers your question, but seems to explain clearly the situation.
x

[momof2]

That link says about sensitising too

[Rebi]

Hi Freddiecat - I am A negative and had Anti-D when I bled in my first pregnancy and after the birth. I also received it after a miscarriage and again in my third pregnancy when I had a bleed and also after the birth (although I have no intention of having any more children).

Policies seem to differ from hospital to hospital. I'm not surprised you're confused! I don't think my experience is of any help, but just highlights how much it depends on the hospital's current opinion.

[mears]

Freddiecat - as a midwife I have concerns about routine anti-D injections during pregnancy. The Guidance is here

There are a number of women who produce antibodies during their pregnancy because of a bleed which may have gone undetected (this happened to me). Once antibodies are produced, they remain forever and will increase during the current pregnancy. When the antibodies appear during pregnancy, the most likely outcome is that the baby may become jaundiced at birth. It is the next pregnancy that may be greatly affected. My second pregnancy developed antibodies and my ds was absolutely fine. He was immediately put under phototherapy incase he developed jaundice which he actually didn't. My next pregnancy was induced 5 weeks early and ds3 needed a blood transfusion at 6 weeks old because he developed anaemia because of the antibodies. My 4th baby dd needed 3 exchange blood transfusions after birth because of the high jaundice levels.
You would think with my history I would support this guidance. However, it is widely recognised that the guidance that has been in place for years of giving the injection postnatally has not been followed properly. That guidance also states indications during pregnancy when it should be given such as any bleeding, after amniocentesis etc. In my own case I had severe pain for a few hours one day when I was 34 weeks pregnant. That was probably when I had a bleed. Some women have 'silent' bleeds though.
There is an assurance that the risk of infection from this blood product is minute. Do we really know? Also, some would argue that the baby is also being exposed to an unnecessary risk as well.
I presume that your husband is Rh Positive because you needed anti-D first time. I think that women having their first baby should have their partners blood group checked prior to blindly being given anti-D. If their partners are Rh negative then they do not need it.

There is a really interesting book about it which questions the use of anti-D book

I've probably given more questions so sorry. It really isn't clear cut. At the moment my area is not implementing the guidance. It is still under discussion.

[hewlettsdaughter]

You might find this link helpful. I haven't read it in detail.
I - and my GP - were expecting anti-D this time round but the midwife checked her file and wrote "Anti-D only for primips prophylactically" in my notes. I think "primips" means first pregnancies so that does seem to be the policy round here.

[hewlettsdaughter]

Mears, that's interesting. My area was giving it routinely in pregnancy five years ago (and they didn't check my husband's blood group - I only found out later, I think from reading another thread on mumsnet, that if your partner is negative you don't need it).

[Quackers]

This is confusing, I thought I had this one sussed but really don't, now I'm worried!! I'm A neg and have had antiD after TOP, 2 threatened m/c's and 2 m/c's. My DH's blood was never checked but I think he's positive as they said I didn't need anti D after giving birth to DD after checking my blood sample. I bled this pgcy too but because I didn't get to see a Doc until a few days after the bleed I didn't get an antiD as it was too late!!!!! Mears if you;re still around what risk is there to this baby given I have not had anti D after the bleed at 6 weeks (now 20). My Doctor is very dismissive and says you will get your antiD at 28 and 32 weeks, don't worry. Sorry to ask more questions, but I also didn't realise that antiD was a blood product. This is quite concerning. Will read all these links and see if I can be more enlightened. Thanks in advance Mears!!

[bossykate]

i am neg and my dh is pos - i'm totally confused about what to do.

[Evie]

Hello all I am also o neg with a husband who is positive and am due to have my 28 week anti D injection tomorrow. I am pregnant with my third child at the moment...I didn't need the injections after 1st and 2nd births as they were also neg but did have a miscarriage between them and was given anti D. I do have a friend who suffered a blood cross over late in her 3rd pregnancy which went undetected and her daughter was born as an emergency with a number of problems. However I still have concerns re receiving it as a matter of course which is done in this area. I have been told that I don't have to have it but again as with the MMR and other interventions we are left with confusing and contradicting evidence and told that the final decision has to be ours. On a final, cynical note the NICE guidelines recommending this intervention aren't normally given to offering treatment if it isn't needed...they are the guidelines suggesting cutting back midwife visits in pregnancy especially to mums not in first pregnancy. It is another worry to add to the number we are all already faced with ie vitamin K etc, etc!

[suzywong]

Oh blimey, I haven't read all this thread I'm sorry to admit, but I had routine anti-D during both of mine. I'm R-neg. I also had a 4 unit blood transfusion after ds2.

Is this something I should be worried about, on a scale of 1-10?

[Freddiecat]

Will read all the links later. Thanks all.

I don't know what my partner or DS's blood groups are. DS was born at 10:30pm on a Saturday night. The hospital routinely give -ve women Anti-D if they deliver on the weekend as the lab may not have time to get the results back and as I understand it, Anti-D has to be given within 72 hours of the birth.

My partner made a massive fuss about the Anti-D in the antenatal ward a few weeks ago and offered to have his blood tested there and then. They couldn't do it and suggested he contacted his GP. He now can't be bothered (typical male!).

I understood that the routine checking of partners blood wasn't done because the mother might well be lying / or unsure of the paternity...