Questions re late loss & Rhesus Disease

[nicjay]

Hi Sweetrainbow,

First of all I am so sorry for your loss - I have not lost a child under circumstances like that so I can only imagine how awful it must be for you

In my life pre-child though, I did work in a large pathology lab where we did testing of mothers with Rh disease, so I may be able to offer some answers from that side of things. I should emphasise though that I have been out of the field for 3 years now, so I may be a little out of date, and I am not a medical expert, but a qualified laboratory scientist, but I do have a bit of knowledge of the subject.

First of all I am wondering how you got the Anti-D in the first place seeing as you had the 28 week and 32 week injections? It is really rare to develop one if you have had the shots. Did they forget to give you another one after the birth of your DS? Seeing as he tested O+, you really should have had one within 72 hours of the delivery.

Also, have you had an antibody screen done fairly recently and was it positive for Anti-D? I ask this because the injected Anti-D can remain in your blood for up to 3 months after the injection and it is not possible to distinguish between it and a "real" Anti-D. Are they sure the Anti-D you have is a "real" one and not the injections?

As for testing during your pregnancy, what they usually do for a start is blood tests on you to check your antibody levels. They can actually measure them and see if they are rising or not. If they start to rise, that indicates that there is more than likely a problem and the baby's red cells are being affected. They should also test your partner's blood to see what Rh typing he is - and they can use that to see what the probability is that the baby will be Rh positive. It will be either a 50% chance, or a 100% chance.

They can also look at your amniotic fluid to get an idea of whether the baby is being affected as well, but obviously this means amniocentesis.

If they think the baby is being affected, they then can treat the anaemia with a blood transfusion in the uterus. I *think* they do it via a needle into the baby's cord and it is done using an ultrasound to make sure it is going into the right place. At the same time they will test the baby's blood to see what Rh group it is (of course if you get to this stage it is generally Rh positive) and if the red cells are affected. They will also test the baby's haemoglobin levels (measuring anaemia) before and after the transfusion. You may find if you need this treatment done and you don't live in a major metropolitan area, that you will have to travel to a large hospital to have it done - not sure about other states, but this is the case in NSW. A lot of smaller hospitals just don't have the facilities and from a lab point of view, a lot of smaller labs just don't come across Rh Disease cases very often.

I'm pretty sure they keep doing this on a regular basis until you deliver - you'll probably be induced early, especially if they think there are problems. Also, the baby will more than likely need more blood transfusions after birth and maybe after a month or 2 as well. Once the Anti-D antibodies are cleared out of the baby's body - I think this can take up to about 4 or 5 months - the baby should have no further problems.

In my time working in the lab (10 years) I saw plenty of Rh disease success stories and very, very few that had an unhappy ending, so I believe your chances of having a healthy baby are great with the correct treatment. It is not like the old days where these babies just couldn't be saved. Just make sure you keep talking to your ob and ask heaps of questions if you don't understand what is going on!

Anyway, I hope this has all helped Hopefully someone else here that has actually been through this might be able to help answer your questions as well.

All the very best for TTCand I hope you are holding a new baby in your arms really soon.