Any midwives/obs/blood/rh- experts? Have had scary letter after birth of ds2 and am panicking.

[pooka]

Hi there

Am rh-. Had ds 2 (third baby) just over 2 weeks ago. Had anti-d antenatally and also postnatally.

Got letter today saying:

"At your recent delivery a blood test was taken which has shown a high level of anti-d in your blood. This is more than we would expect from the prophylactic injection you received at 28 weeks gestation. I think it would be best if we met to discuss this. I am therefore going to send you an appointment to come to the postnatal clinic so that we can discuss this further."

Letter is from the consultant ob/gyn.

It is saturday. There is no appointment in the letter. I am terrified about what this means. Are they worried about ds2? Could he have been/be effected? Is there something wrong with him? Couldn't care less about me, or subs pregnancies, since not having any more children. BUt having been all calm and happy and chilled this time round, am now all panicked that there might be a medical issue with him. I tried ringing the hospital but couldn't speak to anyone who could tell me whether their concern is for me or for ds2. I am assuming (hoping) that since the letter is from ob/gyn rather than paediatric consultant, that is me they need to see rather than ds2, but am not sure.

He has been seen by midwives at delivery, GP the day after. Another GP the week after he was born, another 2 midwife visits and a visit from the health visitor and none have said he appears jaundiced or unwell. Have been signed off by midwives.

Can anybody please please reassure me? Am really upset.

Hi

Can't offer much, only to say if it was urgent, then I think they would have contacted you and booked appat asap. Did you have anti-d after delivery? I am rh-ve and had anti-d after delivey and just wondered whether that may be the cause?

Its a bit crap to send you a letter like that, but as your DS seems well, I wouldn't be too worried. I know you say you have been signed off by the MW, but aren't they supposed to be 'around' so to speak until four weeks post birth? I wasn't visited by my MW after my 3rd child after the first week, but she said I could alsways call her if need be as I would be on her book for 4wks. Just wondered whether you had a number for them that you could call - i am sure they would be happy to advise.

Or what about phoning the delivery suite or something and just emphasising how upset you are?

Sorry not much more help, really

Im no dr, but isnt the risk with the elevated levels more of a problem for future children, which would be why you have an apointement to discuss options if you want more children, i think its more your health thats a concern, so will discuss contraception/future pregnancy strategies

If they thought that there was a prob with ds wouldnt they have refered you to/sent a letter from a paed? Obs/gyn have nothing to do with babies do they, you have to wait for a paed check for discharge

I think from googling, that it indicates that at some point your blood and one of your babies' has mixed, and you therefore have immune anti-D, which could put future babies at risk. Don't worry, just see the doctor

I'm pretty sure it's to let you know that there is a risk in the case of future pgs.

I'm reading it more as though there was too much anti D given with the injection, rather than what pooka's body has made in response to mixed bloods. However, I was of the understanding that anti D only lasts for a certain amount of time anyway which is why you have to have it at 28 weeks - so that you're covered should your pregnancy last to 42 weeks I think.

Thats not much help, is it ?!

Another thought - I thought they only gave anti D postnatally if the babies blood test showed a + blood type ? Do you know if DS was tested ?

I'm sure all will be fine - try not to worry, if urgent they would have called you back straight away.

I am a bit puzzled why they gave you a blood test after the birth to look at your levels. I just had the anti natal jabs, then they tested DS blood he was Rh+ so I had another jab but that was it. Puzzled!

THanks for all the responses! I've calmed down a bit (rang my mother in tears, and she came round in about 15mins flat and did a lot of grandmotherly reassuring "of course he's not jaundiced, what a sweetie!, see he's got great muscle tone etc etc").

I rang the maternity ward who said it sounded more to do with me than with ds2 from the way the letter was addressed and fact from post-natal clinic rather than paediatric. THen rather madly saw next door neighbour in the garden, who happens to be a paediatric/obstetric anaestheology nurse, and made sure to introduce ds2 to her while scanning her face for signs that she could see a problem, before then getting the letter and reading it to her . Just what she wanted on a relaxing saturday afternoon, I'm sure.

I'm also confused about the postnatal blood thing - I don't remember having had my blood taken after the birth (but dh says that the midwife had lots of syringes out - was at home). I know they tested the cord blood, and I know that the results of whatever testing they did told them that ds2 is rh+, hence the post-natal anti-d I had. DD and ds1 are both rh+ too - had anti-d after each of their births too, but not prophylactic injection ante-natally (not offered with dd, and declined with ds1).

I am hoping that I will just be counselled regarding future pregnancies. But wish that the letter a) did not arrive on a weekend and b) was a little more specific in detail, at least giving a reassurance that it is not Joe that they are interested in, or being more specific about it being a maternal issue rather than an infant one.....

But thanks again all who have responded to my panic thread - I'm honestly not usually a worrier or a panicker, but anything health and children related is a dead cert to send me into a flat spin. Actually - scratch that, am usually pretty level about health issues too, when I know what the problem is and have a means of addressing or dealing with it.

I'm now wondering whether the letter is wrong, and they are concerned about increased levels of antibodies rather than anti-d? Again, not something that should affect ds2, I would hope - more a subsequent pregnancy thing????

Agree entirely that if they were concerned about DS2 they'd be making a paediatric clinic appointment, not a postnatalclinic appointment. So whatever it is will be something affecting you, and I'd guess a potential subsequent pregnancy issue.

I dont think that there would be any problem with your DS2, not if he is fine now. The problems that he could potentially have been at risk of would be anaemia and jaundice, if there was no sign of those things then I dont think there is anything else that you need to worry about.

The letter says that they took blood from you when you had your DS2, and its normal to do this, becaue they need to look at your blood to see how much Anti-D you need.

So its possible that you have become senstitised to your DS blood. If you arent having anymore children then that isnt an issue.

Will you update us Pooka? I would be keen to know how you get on xx

will definitely update when have managed to find out what the issue is.

thanks so much for all your posts

I take it we're all RH-

Pooka, what made you decide to decline anti D with DS1 ? Was he your second ? If you don't mind me asking (interested - I've tolerated 2 jabs this pgcy although didn't really want them but can't find that much research on what would happen if I declined...also unsure of DS1's blood type, they never told me )

don't mind being asked at all!

yes, ds was second child. in the time between me having dd and ds1, the prophylactic anti-d was introduced here. i was with a different team of midwives who were dubious about its necessity. also i wanted to avoid having blood product without really good reason.

my thinking was, regular bloodtesting would demonstrate if i was developing antibodies. my booking bloods showed nil, as i'd had the anti-d after dd was born. i was aware of what might constitute a sensitising episode i.e. bump trauma, bleeding etc, ans knew that should get anti-d quickly if that happened.

on balance, took the decision that felt right at that time.

with ds2, i knew that both ds1 and dd are rh+. i figured that had already had 2 doses of anti-d blood product and given that new midwives much more pro, just decided to go with the flow! in the end of course, ds2 also rh+.

Thanks ! I wish I'd held off on the anti D this time around TBH. But midwives made me feel horrific for even considering it as an option . In fact I'll go so far as to say I felt bullied into having it

I'm a midwife and I think the letter is confusing! The anti-d is like chemical blotting paper designed to mask any (RH +) fetal cells so you don't make antibodies. At delivery the baby's blood is grouped, yours is checked to see how many of the baby's cells have escaped into your circulation. Most mums with a rh+ baby just need 1 dose of anti D but a few women need much bigger amounts if lots of fetal cells are found. BUT it's given within 72 hours so can't say why its taken 3 weeks if this is the case. It does sound like you may have already developed antibodies: as already said this is only a problem if you're planning more babies. The levels would need to be closely watched and treated if high (by fetal transfusion:bit complicated. Hope this helps. jo

Thanks Jo, is v. interesting. TBH am not sure what the issue is - as a quick update (ds2 about to wake up!) I rang the hospital and spoke to the consultant's secretary who put me through to the ante-natal clinic and the maternity ward as well. Was reassured by all concerned that the issue is to do with me, not ds2. My notes were looked up and there was some confusion about specifically what the issue is, but obviously (and understandably) no one could commit in the absence of the consultant to what implications are.

Soooo - have an appointment on 5th October with consultant and am sure will leave the wiser. Trying to see the silver lining, will take it as an opportunity to ask for another blood test and to ask that they check my iron levels. Still bleeding and am prone to anaemia, so would be good to get a handle on iron levels too.

Pufflet - me too in some respects. I was having my booking in and expressed doubts about necessity of anti-d prophylaxis. The midwife booking in (not the community ones I had later, who were without exception FANTASTIC) snapped and said "Oh for goodness sake just have the anti-d" while taking my blood pressure, which was as a result a bit high! She checked again 5 mins later and it was back right down (I had been doing some calming down breathing in the meantime). Oh well ....

was baby rh -ve or +ve

puffylovett...saw your post...this is what can happen if you refuse the jab(it can cause haemolytic disease in the foetus and newborn if refused).. BTW it is all documented(or should be that you refuse the injection or not)

this is from clinical paper.....

Hemolytic disease of the newborn, also known as Hemolytic disease of the fetus and newborn, HDN, HDFN, or Erythroblastosis fetalis, is an alloimmune condition that develops in a fetus, when the IgG molecules (one of the five main types of the antibodies) that have been produced by the mother and have passed through the placenta include ones which attack the red blood cells in the fetal circulation. The red cells are broken down and the fetus can develop reticulocytosis and anaemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the foetal blood and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis)

I know, I did read up on the risks. I think I would've felt more confident refusing had I known what DS's blood type was ! I don't recall having an anti D injection after he was born, so potentially that could mean he's RH-ve couldn't it ?

In which case I wouldn't have needed the anti D I don't think . Oh well !

Glad you're seeing someone soon pooka, and at least your mind can rest easier now... hope you're enjoying your DS2 - I can't wait for my new arrival, hurry up baby !

Another update:

Had phone call from paediatric consultant out of the blue today. Was called in with ds for him to be examined and to have blood tests. The blood test showed low haemoglobin, and tomorrow morning we should know what the immature blood cell count (??) is, which will inform whether he will need a transfusion or iron drops.

Am pretty confused generally because was given the assurance that no issue with ds2. But seems that their thinking is that in addition to the prophylactic anti-d, I created my own as a result of a sensitising incident or for some reason, which explains my elevated levels immediately after the birth.

The positives are that once the anaemia is treated, there should be no lasting health impacts for ds2. Bit worried about possible transfusion and what it entails, but hopefully that wont be necessary.... Fingers crossed.

It seems that the consultant haemotologist wrote very shortly after the birth to the ob/gyn and paediatric departments, having sent my blood off for further analysis. Whereas the ob/gyn got in touch quickly, the paediatric department seem to have taken longer (and neither seem to have contact with each other ).

Don't panic. They want to see you to discuss future pregnancies. It will be ok.

Sorry - didn't get thru whole thread, but it sounds as if they are on top of it. They will need to monitor you carefully in future pregnancies though.

Well - not planning any more so thankfully should be a moot point (though when I said this on phone, was told that they've heard that before),