Rh Incompatibility and Why You Need RhoGAM

by Julie Snyder

RhoGAM shotIn cases of Rh incompatibility, a baby's red blood cells have a substance called the Rh D factor, and the mother's blood cells do not.

In medical terms, the baby is Rh positive and you are Rh negative.

If some of the baby's red blood cells leak into your system, your body may produce antibodies to the Rh D factor. This is a condition called sensitization.

These antibodies can cross the placenta and destroy the red blood cells in your unborn baby or in the next Rh-positive baby you have.

How Does it Occur?

This condition only occurs if you are Rh negative and your baby is Rh positive. It does not occur if you are Rh positive and your baby is Rh negative.

In most cases you will not be exposed to the baby's blood until you give birth. This usually means that your first baby is not affected. However, large amounts of the baby's blood often leak into the mother during delivery.

If you are Rh negative, the next Rh-positive baby you have could have problems if you have developed antibodies. Occasionally, in the following situations, some of the baby's blood may leak into your system during pregnancy:

  • After amniocentesis or other invasive procedure
  • During a miscarriage or abortion
  • During an ectopic pregnancy
  • If you bleed heavily during pregnancy.

If you are Rh negative and you received Rh positive blood in a transfusion, you may have developed antibodies that will cause the issue. In most cases, development of antibodies (sensitization) can be prevented, but if antibodies are formed, they will cross the placenta and can cause serious damage to the red blood cells of an Rh positive baby.

What are the Symptoms?

You won't have any symptoms. Symptoms and signs of the problem are seen in the baby if he or she develops hemolytic disease. In this condition, the baby's red blood cells start to break down, causing anemia. The baby may have other problems due to the anemia, such as jaundice and, after birth, breathing problems. The baby might even die in the womb if too much of the baby's blood is destroyed.

How is it Diagnosed?

Women at risk for this condition can be identified with the routine blood tests done at prenatal visits with the doctor. The tests include:

  • Blood type
  • Rh type
  • Antibody screening

If you're Rh negative and have antibodies against the Rh D factor, you could have an issue. If you're Rh negative, the blood of the baby's father should be tested. If the father's blood is Rh positive, the baby has a chance of inheriting Rh-positive blood from the father. If the father is Rh negative, there will not be a problem because the baby has no chance of inheriting Rh-positive blood.

Some of the tests used to diagnose and assess hemolytic disease in the baby before and after birth are:

  • Amniocentesis
  • Cordocentesis
  • Ultrasound
  • Non-stress tests
  • Blood tests

How is it Treated?

If you've already been sensitized by a previous birth, your baby may develop hemolytic disease before birth. If this happens, your baby may need a blood transfusion in the womb before birth. Sometimes early delivery by cesarean section is necessary.

If you haven't been sensitized, you will be given an injection of Rh-immune globulin at about 28 weeks of pregnancy, and within 72 hours after a birth, miscarriage, abortion, or amniocentesis.

The Rh-immune globulin contains antibodies to the Rh D factor. These antibodies will destroy any red blood cells from the baby that have entered your blood. You will not have a chance to form your own antibodies to the Rh D factor.

If you receive the injection at 28 weeks and after delivery, sensitization will be prevented and Rh incompatibility should not be a problem during your next pregnancy.

It's important to receive Rh-immune globulin in all cases when the baby's blood could leak into your system, including:

  • All pregnancies including ectopic (tubal) pregnancies
  • Early miscarriages
  • After chorionic villus sampling
  • After amniocentesis

Should All Rh Negative Women Receive Rhogam?

If you are an Rh-negative woman and you've conceived with an Rh-negative partner, you're not at risk of Rh sensitization during pregnancy. Your health care provider will confirm your partner's Rh status. You won't need Rhogam.

Most women don't require Rhogam during their first pregnancy. Some situations that cause the mom and baby's blood to mix include a previous pregnancy loss, amniocentesis or CVS, trauma to the abdomen, c-sections and pulling on the cord or placenta after birth. If you've experienced one of these events, it might be wise to consider a 28-week Rhogam shot.

In addition to unnecessary shots, Rhogam should not be given to anyone who has immune globulin A deficiency or hemolytic anemia, a condition characterized by insufficient healthy red blood cells. If you have ever had an allergic reaction to immune globulin, you should not receive Rhogam.

How Long Will the Effects Last?

Sensitization usually doesn't happen until after the birth of an Rh positive baby. This condition isn't a problem during a woman's first pregnancy and delivery of an Rh positive baby.

However, subsequent pregnancies and deliveries could be affected unless the mother is treated with Rh-immune globulin after every birth, miscarriage, and abortion.

Sensitization is permanent and the effects are usually worse with each subsequent pregnancy. Luckily, this condition doesn't occur as often since the discovery of RhoGAM.

Have you been through this or about to be tested? Share your experiences!