RhNegative Blood Type and Pregnancy

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Rh-Negative Blood Type

and Pregnancy

What is blood type?

Your blood typetells you aboutmarkers on the surfaceofyourredbloodcells. The redcells in your bloodcan

be A, B, AB, or O. The redbloodcells alsohaveaprotein that iscalledRhonthesurfaceof the cell. Your blood

can be Rh positi

ve, whichmeans that you havetheRh protein, or Rhnegative, whichmeans that youdonot

havetheRh protein.The letter ofyour bloodgroup plus the Rhmakesyour blood type.Youcan be O+,O−,

A+,A−,B+,B−,AB+, or AB−.Atestthattells y

ouyour blood typeisdone at your first prenatalvisit and

usually when you are admitted to the hospitalfor labor ifyou are planning ahospitalbirth.

Why is my blood type important?

If you ever need a blood transfusion,youshould be given blood that isyour same blood type.Youcan become

verysick ifyou are given blood that is a different blood type unless it isOblood, whichwill not causeharmto

peoplewhohav

eotherblood types.

I am Rh negative. What does this mean for my pregnancy?

BeingRhnegativemeans that youdonothave Rh proteins on yourredbloodcells. If your baby isRh positive

andyouget a small amount ofyour baby’s blood into your circulation (bloodstream) when you are pregnant or

when yougive birth,you

r body can makeantibodies that hurt andkill redbloodcells that are Rh positive.

The most likely time that you would beexposed to your baby’s blood is when yougive birth.This is whybeing

Rhnegativewill not harm your baby durin

gyour first pregnancy. Butinyournext pregnancy, the antibodies

that you madewhenyou were exposed to Rh-positive blood at your first birt h can cross the placenta and attack

the Rh-positiveredbloodcells, ifyou

rnext baby hasRh-positive blood. This iscalledRh sensitization.Rh

sensitization can cause fetal anemia (low iron in the blood), miscarriage,stillbirth, or a serious illness in the

baby that iscalled hemolyticdiseaseof the newborn.Fortunate

ly, Rh sensitization isvery rare becausewomen

who are Rhnegative can get a shot that stops their body from making antibodies to Rh-positive blood.

What is RhoGAM?

RhoGAM is amedicine that stops your bloodfrom making antibo dies that attack Rh-positive bloodcells.

RhoGAM is a sterilizedsolution made from human blood that contains a verysmall amount ofRh-positive

proteins. These proteinskeepyo

urimmune system from makingpermanent antibodies to Rh-positive blood.

Theydonothurt your baby. RhoGAM isgiven as an injection (shot).

When do I get RhoGAM?

Althoughthechanceofyour blood and the baby’s blood mixing is highest at the time that yougive birth, which

rarely happens, it can alsohappen during the lasttrimester ofyour pregnancy, when your placenta isgrowing

and the membranes that separate

your bloodfrom your baby’s blood are very thin.For this reason,RhoGAM is

given at 28 weeks ofpregnancy to protect youfor the restofyour pregnancy. RhoGAM works for about 13 weeks.

Soon after yougive birth,your baby’s blood will bete

stedfor Rh.Ifyour baby hasRh-positive blood, you

will get another doseofRhoGAM within 72 hours after yougive birth.Ifyour baby’s blood isRhnegative,you

will not need the secondRhoGAM shot.

Are there any other times that I might need RhoGAM?

RhoGAM is also given anytime that your bloodcould come into contactwithRh-positive bloodcells, suchas:

Anyvaginalbleedingduringpregnancy

Miscarriageorabortion

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725

American College of Nurse-Midwives

www.sharewithwomen.org

Chorionicvilli sampling or amniocentesis(testsfor birth defects)

Injury to yourabdomen (belly), suchas a car accident or fa ll, duringpregnancy

Externalversion (turning a breech baby sothebaby is headfirst)

If you are Rhnegativeand any of thesethings happen to you, youshould contact yourhealth care provider

right away. Youshould get a RhoGAM shot within 72 hours of the poss

ibleexposure to Rh-positive bloodfor

the shot to workbest.

HowsafeisRhoGAM?

RhoGAM isverysafe.Itis recommendedfor all pregnant women with Rh-negative blood typeand hasbeen

usedfor about 50 years. Although RhoGAM is made from human blood, only the verysmall Rh pieceisused.

There is a very rare chancethatyo

ucould get an infection suchasHIVor hepatitisfrom RhoGAM, butthis is

so rare that there are no reports of it happening. There is alsoavery rare chancethatyou will haveanallergic

reaction to the RhoGAM that causesfever andchills or shortness ofbreath.Itis more common to haveasmall

reaction li

keredness or swelling where the RhoGAM was injected, usually your upper arm or buttocks.

Itis important to know that the risk ofdevelopingRh sensitization is muchhigher than the risk ofproblems

from the RhoGAM shot.Oncethathappens, all future pregnancies are at risk for the b

aby beingverysick or

dying if the baby isRh positive.Therefore, not takingRhoGAM is muchmoredangerous than takingRhoGAM.

Are there women who should not get RhoGAM?

If you havehemolytic anemia, or you havehad an allergic reaction to a shot of immune globulin, or you already

have Rh sensitization,youshould no t get the RhoGAM shot.

Is there anything else I need to know about RhoGAM?

Itisbestnottoget some vaccines within 3 months of having the RhoGAM shot.This is not usually a problem

becausethevaccines that donotwork well after getting a RhoGAM shot are never given to pregnant wo men.

This issomething to think aboutifyou are

planning to travel outof the country within 3 months after giving

birth to an area where you need a vaccine called a “live-virus” vaccine.Ifyou are in thissituation, talk to your

health care provider before you are given the RhoGAM shot.Als

o, ifyou haveany religious or culturalconcerns

abouttaking a bloodproduct,youshould talk to yourhealth care pro vider or religious leader abouttherisks

andbenefits.

What if I do not choose to get RhoGAM?

Aboutonein5 women who donotget RhoGAM will get Rh sensitization, which cannot be fixed onceithappens.

If youdonotget RhoGAM duringpregnancy, youshould get your blooddrawn regularly in the lasttrimester

to see ifyou have become Rh sensitiz

ed. If youdo become sensitized, tests to see how your baby is handling

the problem will beoffered. If the baby has a serious problem,you may need to beinduced to give birth early.

For More Information

March of Dimes: Rh Disease

http://www.marchofdimes.com/baby/rh-disease.aspx

How RhoGAM Works

http://www.rhogam.com/images/content/Teaching-Chart-Large.jpg

A merican Red Cross: Blood Types

http://www.redcrossblood.org/learn-about-blood/blood-types

ispagemaybereproducedfornoncommercialusebyhealthcareprofessionalstosharewithclients.Any

other reproduction is subject to the Journal ofMidwifery&Women’s Health’s approval. e information and

recommendations appearing on this page are appropriate in most instances, but they are not a substitute

for medical diagnosis. For specic information concerning your personal medical condition, the Journal of

Midwifery&Women’s Health suggests that you consult your health care provider.

726 Volume 58, No.6,November/December 2013