Please help. Second pregnancy, Rh negative, and confused about Anti D!

[gaelicsheep]

OK, in short the story is this. I declined Anti D during my first pregnancy but had it after the birth of my DS. I'm now pregnant with my second and have to decide very soon (ie tonight, so I can ring the MW for her to order it) whether to take up the offer of antenatal Anti D at 28 weeks. I don't plan to have any more babies.

I've been trying to read up on this and my brain hurts (it's been a hard day at work!). Basically what is confusing me is the following:

1. Sensitisation events, including silent sensitisation, rarely affect the current pregnancy. What does rarely mean? Is there a risk to this baby or not basically?

2. Having had Anti D after delivery, and having had no antibodies detected during routine blood tests is this baby at any increased risk in this pregnancy as opposed to my first pregnancy?

3)Is there any chance of actually being already sensitised even though no antibodies were detected?

4. If I am already sensitised from my first delivery would having Anti D make any difference at all to this pregnancy in any case?

Answers to any or all of the above would be really helpful. I've read the NICE guidelines and several articles but I still don't feel I have a grasp on whether there are any more risks to the baby from rhesus disease this time around.

Thanks

re: postnatal anti-D - my DD was born on a sunday lunchtime, and they said they would test the cord blood so i could wait and see before having the injection. By 1pm on the monday still no blood test result and i refused the stay on the post natal ward any longer so we left (that was only matter outstanding) - but had to go back that evening for the injection as she was Rh+.

DS born on sunday night but the monday was a bank holiday - asked for the injection without waiting to find out his blood group as certainly was not hanging around until tuesday evening to find out. was discharged on the monday morning.

this time will be asking for it to be done immediately unless blood test results can be done within a few hours. i need to have a knack of giving birth at weekends (for the 3rd time have a EDD on a friday)

what are the other options??

Unfortunate timing on your behalf there MumNWL! Depending on the individual hospital's blood transfusion lab's policy, cord bloods are not generally tested as part of the emergency service, which operates "out of hours". When it is one person "on call" out of hours, usually covering both transfusion and haematology labs, then cord bloods rarely constitute an emergency and are therefore often left to routine hours. However, in our hospital we had "routine" hours on a Saturday morning, so the worst time to have had a baby would have been Saturday afternoon. Monday mornings are usually pretty hectic with picking up all the routine work that has been accumulating over the weekend, so monday afternoon is a pretty standard sort of time to get a result from the weekend, ime.

This changes a bit when a 24h lab service is provided, as most things do get done - but emergency blood requirements will still take precedence over routine.

If you want to create an emergency, a post-partum haemorrhage is the way to go - that way, it becomes quite important to get the cord blood and the Kleihauer test done quickly. (NOT RECOMMENDED) Ditto if the baby is born jaundiced.

I agree bad timing - although upside is that labour ward etc is quieter at weekneds and hence better one to one care.

TBH as I have had the injections during pregnancy I don't mind just having the injection as a precaution without waiting for the results, will certainly do again if have another weekend baby! As DH (and DD) RH+ there is a pretty high chance that the baby will be RH+ as well.

Would prefer not to create emergency thanks as want to get home ASAP - (hence reason not wanting to wait when DS was born) I suspect that an emergency situation would necessitate longer hosital stay! Of course possible to go home on the basis you'll come back if baby RH+.... but with DD we left without a discharge, not sure they'd have discharged us.

MumNWLondon - the community midwives brought me the anti -d when they did their home visit the day after we got home (when they'd confirmed the rh status). You could ask... Or perhaps this is another area dependent thing...!?

Just a wee update. I had to go to hospital yesterday with a slight bleed - tests showed it was probably down to cervical ectropion and not from the womb. Anti-D was recommended in any case, but a lower dose than the propylactic one (500 rather than 1500, which I can't quite get my head around ) pending the results of the Kleihauer test they did. So the upshot is that I got the lower dose I was happier with, plus a decent antibody test has been done which will give a result untainted by the anti-D. A pretty good compromise all round - scary though and not something I want to repeat.

sorry to hear you had a bit of a scary day, gaelicsheep - glad it's turned out ok.

Re. the dosage - 500iu is the one they normally use for 28 and 34 week prophylaxis if on a 2 dose prophylaxis regime; the 1500 is for a one dose prophylaxis, to be given between 28 and 30 weeks. They might also use the higher dose if your Kleihauer test had shown any foetal cells, depending on how many were seen.

Thanks thumbwitch - it was very rude of me not to respond sooner - sorry! I'm feeling much more relaxed about it all now and there's been no more bleeding, touch wood! I understood about the two difference regimes, but three times the dose seems a bit excessive to me. Glad I got the lower one in any case (and I've heard nothing following the Kleihauer test so presumably all is OK).