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Pregnancy

Talk about every stage of pregnancy, from early symptoms to preparing for birth.

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Original poster

Anti-D question

60 replies

Cosmogirl · 09/01/2009 16:12

Hi ladies,

Wondered if any RH negative ladies can answer a quick questions. I just had my anti-D jab today at 28 weeks (first baby). Had to go to hosp where I am due to give birth as community midwife in our area don't do it. The lady who did it said that I would only need the one jab (unless I have a bleed). However, I was under the idea you have two - one at 28 one at 34 - even says this in my notes.

Is she giving the correct info?

TIA.

Ps. Was very pleased as it didn't hurt like I thought it would. She did it in a fleshy bit of my thigh. Arm where she took the blood hurts like hell though! Feels really stiff and achey.

OP posts:

Are your children’s vaccines up to date?

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jennylindinha · 09/01/2009 16:19

Hi Cosmo, I guess it depends on hospital policy. I had my anti-D injection at 28 weeks but it was a triple dose as they had run out of the normal one (and hurt like hell as they did it in my arm!) When it got to 34 weeks they didn't bother because of the triple dose, but I did have another one after the birth 'cos my DD was Rh+.

I'm not necessarily convinced that it mattered that I'd had triple the first time but they didn't think I needed one at 34 so I was happy not to have one! Hopefully someone else will come along knows the full story. Best of luck!

SheWillBeLoved · 09/01/2009 16:20

I was told i'd need a 2 part dose, first at 28 weeks, second at 34.

Original poster

Cosmogirl · 09/01/2009 16:21

Thanks Jenny. Yes she did say something about it being a big dose that she gave. That could be it the. Sorry yours was painful! Glad she did it in my fatty thigh area now!

OP posts:

pooka · 09/01/2009 17:02

I think when I was pregnant with ds in 2005, there were 2 jabs.

Of course in 2003 they didn't routinely give anti-d during pregnancy!

I opted out of the routine anti-d jabs during pregnancy with ds.

Both dd and ds are Rh+. I had anti-d injection for each within 48hrs of delivery. No antibodies during second pregnancy.

electra · 09/01/2009 17:05

Where I live I think they give two. However, when I had dd1 it was not routine and was only offered after the baby was born, if Rh+. I am supposed to have mine soon but will probably decline it.

And yes, they should not give it in the arm - my arms are very small and I always made them do it in my bum.

EmmaPP · 09/01/2009 17:31

im also Rhesus D negative, and my notes said 28 and 34 weeks like yours. if that's what your notes say, you should ring and insist on another one - sometimes hospitals are overstretched and can overlook things a little i've found.

franfoxy2003 · 09/01/2009 17:40

i had one at about 28 weeks and after i had given birth, within a few hours, not sure why though

thumbwitch · 09/01/2009 17:41

you should be scheduled for 2 jabs at 28 and 34 weeks. I don't know about being given double/triple doses, that shouldn't be general practice.

electra, why would you decline it? If your first baby was Rh neg you won't have made any antibodies from that pg, but if this baby is Rh pos, you could potentially still make antibodies through the pg, which is why the prophylaxis is usually given during the pg. I am sure you MW has explained to you the risks of having your own anti-D antibodies in your blood and a Rh pos baby - the risks to the baby vary from negligible to fatal. The anti-D after giving birth is to protect any future babies you may have.

MKG · 09/01/2009 18:04

I'm in the US and we only have it 28 weeks and then after the birth.

Maybe your hospital has changed it's practices without telling you?

thumbwitch · 09/01/2009 18:15

it would be a cost saving, that's for sure. There is possibly variation in different PCTs around the country as well. (usual postcode lottery)

olivo · 09/01/2009 18:28

you're lucky, we don't get it any more routinely, except after the birth.

electra · 09/01/2009 18:49

Hi thumbwitch - well in the past I have always had it after the baby is born and I will again after this one. But I prefer not to have it in pregnancy because it is a blood product and therefore does carry an unquantified risk. Some of the preparations also contain the mercury derivative thimerosal, and I try to avoid potential triggers as I have a child who has ASD.

pooka · 09/01/2009 18:51

Thumbwitch - when I declined anti-d antenatally with ds (am Rh- and dd was Rh+) it was because, by my understanding, if I was being regularly blood screened (which I was), those screens would detect any production of antibodies, or if I had a fall or other bump trauma, in which case I could then have the injection as necessary rather than as a preventative measure.

Then after delivery, if ds was Rh+ I could have the anti-d postnatally, as I had with dd.

This was my reasoning, and the midwife privately agreed with me when I said that I wanted to avoid unnecessary blood-product injections as far as possible.

IN the end, ds was Rh+ and I had anti-d shot after delivery, as I had previously with dd. With the next one, TBH I'm not sure what I'll do. Obviously I'll have the frequent blood tests that are recommended for Rh- mothers. But I'm not sure whether I would be so averse to the prophylaxis injections of anti-d.

pooka · 09/01/2009 18:52

At the same time, I don't understand what changed to make it desirable to give the injections routinely, and I still would prefer to avoid unnecessary injections.

Ireguina · 09/01/2009 19:00

Blood is a tissue that is renewed every 6 weeks. The anti-D has antibodies that would latch to the possible red cells (+) from the baby. Hence, if used as a prophylactic, it should be given twice, at 28 and 34 weeks. There are possible adverse effects, such as premature birth of the baby and other complications, as anti-D is made from human blood. Also, it uses mercury as a preservative and that has been associated with autism. Has DH been tested for his Rh? I was told that they don't test fathers because 25% of the time the father is not really the father . I am Rh-, but DH is also Rh-, so I did not have it.

Overtiredmum · 09/01/2009 19:00

I am A Rh Neg and had 2 jabs when expecting DS (2005) and one after birth. Am now expecting again and they have changed the policy where I live and now give a double dose at 28 weeks, and then again after birth. HTH.

Diege · 09/01/2009 19:22

Hi COSMO . I'm also rhesus ned (A) and my hospital changed its policy when I was pregnant with dd3. Was formally 2 injections, 28 wks and 34wks, then one after birth. Tis now a double dose at 28 weeks and one after birth (midwife said for 'economic reasons' ). Think this will probably be the case with you, though worth checking to put your mind at ease.
Just thinking I may not need one with this pregnancy as it's def my last? Does it work like that? (and no.4 is def my last - am getting my tubes done!!).

electra · 09/01/2009 20:09

Yes, if it is deffo your last you don't need to have it. The reason for having it after a baby is to protect future babies.

pooka · 09/01/2009 20:20

Cool - next one would be the last!

DH definitely Rh+ (both the dcs are too).

I think I will decline if offered next time.

Ireguina · 09/01/2009 21:14

It is not just to protect future babies. If you have been sensitised to Rh+ (from a prev. pregnancy) your body will attempt to destroy the baby you are carrying if it is Rh+. At the beginning, the antibodies produced will be too big to cross the placenta and it is not until around 6th month of pregnancy when your body finds out the way of making them small enough to cross and attack the baby. This would result in a late miscarriage, which can be extremely dangerous for the mother as well. The anti-D would "catch" the red cells from the Rh+ baby, so your body does not realise there is a Rh+ baby. That is why it is very important to monitor your blood and have the anti-D during each pregnancy if there is any risk of previous sensitazion (like from a previous pregnancy).

pooka · 09/01/2009 21:20

But would the fact that early bloodtests and those later on show no antibodies mean that the injection ante-natally would be superfluous?

Also, if with both previous pregnancies (with Rh+ babies) I have had the anti-d post-natally, to mop up any antibodies, would that mean that I was starting with a blank slate as it were, or is that too simplistic?

Am finding this very interesting.

Also! Another question in case anyone knows. Does blood typing work like genetics in terms of + overpowering - like dominant (brown) overpowers recessive (blue) in eye colour for example.

Is it guaranteed that next baby will be A Rh+ as has A Rh+ father, or could it be A Rh- like me?

Fascinating stuff.

Ireguina · 09/01/2009 21:30

There is exchange of fluids between mother and baby during pregnancy, that is why they give you the ante-natally injection. Also, you get an anti-D at birth, but there is not guarantee that it will trap all the red cells from the baby (higher volumes of fluid exchange during birth).
Rh- is indeed recessive, however, the rules of link-crossing (I think it is called like that in English) are not always that simple and there might be some cases where there is a "masked" dominant Rh+ (but it is very rare).
The next baby could be Rh- if father has a recessive Rh- and a dominant Rh+.

pooka · 09/01/2009 21:35

Thanks for that Ireguna - is very interesting.

electra · 10/01/2009 11:41

Ireguina - I disagree that it is very important to have anti-d in pregnancy routinely. Anti-d was originally introduced after delivery only - to protect future babies, because sometimes blood was exchanged at delivery.

At that time, any extra anti-d shots in pregnancy were only recommended if the Rh- woman had experienced a 'sensitising event', usually a trauma to the bump, or a bleed.

The reason the routine anti-d was introduced was because some people fail to report these incidences because they don't know the significance, or sometimes because they suffer domestic violence and are ashamed to report it.

So for myself I don't consider it necessary and would prefer to leave it to my own discretion.

spats · 10/01/2009 12:53

I work in a hospital transfusion centre and we have only just started routinely administering anti D prophylactically. Before this a women would be offered anti D after a trauma and also we would look at the womens blood and see if there are any foetal cells in the maternal circulation,This is the point where the foetal cells can cause the mother to produce anti D. If there are foetal cells (which i have never seen, so rare!!) a higher dose of anti D may have tobe calculated. I think is has been routinely offered as we are too like America and someone will sue the hospital if they happened to produce some anti D. My two DS were born before routine anti D and i had the Jab post delivery. At this point the same test (Kleihauer) would be done to see if there are any foetal cells in the maternal circulation. Usually there is not so the anti D jab is enough to protect you. I am ttc no3 and am not convinced that i would take the anti D prophylactically unless i had a trauma. It is a human blood product and whilst it is deemed safe there is still unknown viruses lurking which i think we haven't discovered so i don't feel it is necessary. Post delivary , absolutely as not having it is riskier.

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