Anti-d immunoglobulin

[Socci]

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[Rowlers]

I had to have anti d as I am Rhesus neg and had some small bleeds. I had the injections later than the recommended time of up to 72 hours after bleed and was very worried TBH about whether it would work / implications for baby and / or future pregnancies. I think it would be a good thing. I'm not aware of any risks though. It would cut down on potential problems. I think it is routinely given in other countries, the US for example? I may be wrong.

[Socci]

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[Pidge]

Am reviving this thread to see if anyone has any more thoughts on this.

I am 26 weeks pregnant and rhesus negative. My midwife has just told me that new NICE guidelines recommend women like me getting pre-cautionary anti-D at 28 and 34 weeks. Previously you were just given anti-D at the birth, or if you had a serious knock or a bleed during the pregnancy.

My local hospital (King's) leave the final decision on this to the individual so now I'm trying to decide what I want to do. My basic instinct is that the benefits outweigh the risks, but ...

One question is - can they test your blood at 28 weeks to decide if you really need the anti-D injection?

Also - how much benefit does the injection really bring. After birth there seems to be a 72 hour window in which the anti-D has to be given, so does getting the jab at 28 and 34 weeks really guarantee that you will have no problems at all should there be cross-contamination of the mothers blood in the following weeks?

Does anyone actually know what the risk is of having a problem if you don't take the routine anti-D during pregnancy?

Anyone any thoughts?

[Socci]

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[coppertop]

I'm Rh neg and dh is Rh pos. Both boys were Rh pos but I only had Anti-D after the actual birth when the blood test results came back. I thought it was only needed during pregnancy if you'd had a previous m/c, bleeding etc. If I were to gt pregnant for a 3rd time I think I'd turn down the precautionary doses tbh.

[coppertop]

By "precautionary doses" I mean the ones that some women seem to be offered during the actual pregnancy. I would still have the anti-D after the birth if it were needed.

[Linnet]

Pidge do you know your Dh/Dp's blood group?

If he is RH- and you are RH- then there is no need for you to have the Anti-D as the baby will be RH-.

I was pregnant with my 2nd child last year when I discovered that they had changed the guidlines. I told the hospital that we were pretty sure my Dh was also RH- but would they please check his blood to make it 100% certain. the hospital refused to do a blood test on him so we got it done ourselves by the nurse at our local surgery. Dh is indeed RH- like me and both our dd's. The hospital won't automatically check DH/DP's incase they aren't the father of the baby, that is their rule.

In the end I had to have one dose of Anti-D after my amnio as we hadn't had my dh's blood tested at that point but I took great satisfaction in pointing out to them at later appointments that No I didn't need to have the Anti-D.

I started a thread on this last year which is hear, Mears posted some guidelines that were very interesting to read, it says in them that a woman doesn't need to have the Anti-d if she knows her Dh/Dp's blood group and he is proven to be RH-.

my thread

[Linnet]

please ignore typos in that post, trying to feed baby and type at the same time.

[Pidge]

Socci - if you don't mind me asking - why do you regret having the routine anti-D?

Coppertop - my dp is also Rh positive, so kids could go either way. Bizarrely I can't remember what happened after dd's birth. I have no recollection of having the anti-D, so maybe she turned out to be Rh -ve. I hope they didn't just forget!

I have no objection to getting the anti-D after birth, if the baby is Rh +ve. But I'm really not sure what to think about the routine jabs. King's London (my local hospital) seem to be on the fence, offering it as an option, but leaving it to the individual to decide.

[Pidge]

Linnet - sorry posts crossed - as you can see my dp is Rh +ve. Otherwise I would have no hesitation in turning down the jabs.

[Socci]

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[Pidge]

Thanks Socci.

I've now done a search through archived threads and read all mears's brilliant advice on this. Am now going to talk it over again with dp to see what he thinks. He was quite keen for me to have the routine anti-D. I was inclined to agree with him, but am really wondering if it's necessary.

[Mirage]

This is interesting-I am RHneg & despite 2 bleeds during this pregnancy,have been told that I don't need a jab.I had 2 heavier bleeds with dd,when I did have a jab,as well as after her birth & when I had my ectopic.

My gp said last week that there are moves to give it to all Rh neg women routinely at 28 weeks.Personally,although I've been glad to have it when needed,I would be very much against having the anti-d just because someone has decided that I should.

Isn't there a test called the Kleinhauer (sp) test,that checkes wether your body is actually producing antibodies & that you therefore need the jab?I am sure that I had this test before any of my anti d jabs.

[misdee]

with last 2 pregnancies they check my anti bodie teirs and came back fine so didnt have anti-d during pregnancy, this time they want to jab me at 28/34 weeks instead of just the blood test. might just ask for the blood tests to be done instead as i am at the hospital the same day having a GTT done.

[fisil]

with ds I had it after his birth. With mc & this pg I had to have it done cos of bleeding early on. So now the hosp want to do it at 28 & 34 weeks - their new policy - and I don't see why not - I've had it for other reasons before knowing baby's blood group, when it seemed perfectly logical, so it doesn't seem illogical any more, iyswim!

[honeybunny]

I'm Rh- and dh is Rh+, and I've never been given routine anti-d during any of my 4 pgs, only after. I was at Kings (London)for my first 3 pgs (under Maggie Blott) and I distinctly remember her telling me that unless I had a major bleed during the pg I wouldnt need anti-d, it was totally unnecessary. The routine 28 and 34 weeks dose are offered in the unlikely event that you suffer a bleed, but as its only effective for a short period, less than the 6weeks between these doses it doesnt really cover you for anything. (This is from memory-3yrs ago, so may well be wrong). I'm now in Kent so using different hospital but the advise has been the same as far as I can tell. And they will test my new baby's blood for her blood group before stabbing me with unnecessary anti-d here too. Which was the same procedure at Kings last time.

[ZoeC]

I'm rh- and dh is rh+ - when pg with dd I was just tested during pg for antibodies and then dd was blood typed at birth- presumably -ve as they told me specifically I didn't need the anti-d.

This time it seems to be the same, although routine anti-d does seem to be happening more and more. I have been reading up on this recently and don't want it routinely - it's a blood product, which is never 100% safe so if there's no reason to give it I don't see the point. After the birth, if this baby turns out to be rh+ I suppose I'll have to, although saying that I'm not planning on having any more so I don't really see the benefit.

Has anyone been tested for antibodies after the birth instead of just going on baby's blood type? I've read that bloods crossing doesn't always happen, and especially unlikely if the third stage isn't 'managed'.

[whizzz]

I am Rh neg & so is DH, despite me telling our hospital this & not really seeing the point of it, I had routine anti D. Seems a bit silly really.

[Slink]

I had injections during my first pg and then after dd was born as she was rh plus i am neg, no risk though

[Pidge]

Thanks so much for all the responses here - as I said I also did a search of archived threads on mumsnet and found loads of useful information. The Royal College of Midwives had a link to the following article , which I found interesting. By the end of yesterday I was beginning to think that maybe I didn't want to have the routine anti-D after all. Dp had been very keen for me to have it, but I showed him a printout of some threads from mumsnet and that article and he also began to have doubts. So I think I'm going to decline the offer of the routine jabs - though of course I'll get anti-D if needed at the birth, or if I have any bleeds or whatever.

[mirashark]

Hi
just starting this thread again as I have been doing serious research and it's very nice to see other people with the same ideas as me. Having and anti-D shot after the birth of a Rh +ve baby is a risk worth taking but these new Routine ones are as someone so rightly put a 'one size fits all' blanket. The risk of HDN with the postpartum (after birth) shot is about 1.12%. With the Routine Ante-natal shots as well it goes down a bit more to about 0.8%. Such a tiny improvement for the risk of having a blood product injected into you when the baby is still inside. then the baby coudl be negative itself and it was all for nothing. They even mention the 'speculation' about the risks to the unborn in the NHS guidelines but downplay them. The fact that they do not even test the father is quite infuriating although I can see how it could be irresponsible of them to presume that he is the father but it's just one more reassurance if he's Rh -ve that if you do decline the routine jabs in your heart you know the Dad is negative so you can relax, even if they can't! I just think you have the right. I am declining the routine jabs after much much research. I was just going blindly along when it came to my attention that this is a blood product and sometimes even contains a mercury called Thimerosal which I definitley do not plan to expose the baby to. It seems ridiculous that they will tell you to avoid eating this and that and then shoot mercury into your veins with the baby on board. Anyway, that has mainly been outlawed as far as I can tell. Still waiting for the hosp to supply me with full details of the exact Anti-D they will administer in case of a positive baby and there's so much info online it's great.

[hushh]

If anyone is interested I was given ANti D (D-GAM) last week (after a miscarriage at 6.5 weeks). Unusually, I was given the Patient Info Leaflet by the lovely nurse who jabbed me. The shot I had didn't contain any mercury based additives - the only thing listed is sodium chloride (salt), glycine (a stabiliser) & sodium acetate /sodium hydroxide to control alkalinity. If anyone wants any more info off the sheet - let me know !

[pooka]

I'm also going to opt out of the routine anti-d, even though dd pos, and dh pos. My blood will be tested at 28 and 34 weeks for anti-bodies anyway, and I'd get a shot if had bump imjury or bleeding. I just feel a bit iffy about overdoing blood products unnecessarily. But it is all very confusing as I'm no scientist.

[mirashark]

Hushh sorry to hear about your miscarriage. Glad you got the right treatment and information. For anyone else interested in this product here are a few links - all the info is out there if you have the boredom threshold to plough through it but you don't need to be extra clever either, just weigh it all up.

emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=14734#TOP

emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=14629

[mirashark]

admin.safescript.com/drugcgic.cgi/INGR?67387713+0#pregnancy

hmmmmm (Marge Simpson style groan!)