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DESCRIPTION
Rh Isoimmunization (Erthroblastosis Fetalis) occurs when there is an incompatibility between an infant's blood type and that of its mother, resulting in destruction of the infant's red blood cells (hemolytic anemia) during pregnancy and after birth by antibodies from its mother's blood.
FREQUENT SIGNS & SYMPTOMS
Signs during pregnancy:
- Decreased fetal growth.
- Decreased fetal movement.
Signs in a newborn:
- Paleness.
- Jaundice (yellow skin and eyes) that begins within 24 hours after delivery.
- Unexplained bruising or blood spots under the skin.
- Tissue swelling (edema).
- Breathing difficulty.
- Seizures.
- Lack of normal movement.
- Poor reflex response.
CAUSES
The fetus of an Rh-negative (blood type) mother and an Rh-positive father may be Rh-positive. If the father is known to be Rh negative, there is no concern. During delivery, a small amount of the infant's blood is absorbed by the mother through the placenta or by a medical procedure stimulating her body to produce antibodies against Rh-positive blood. The antibodies are produced after delivery, so the first infant is not affected. With succeeding pregnancies, the antibodies in the mother's blood can potentially destroy fetal blood cells. With subsequent pregnancy, anti-Rh antibodies cross the placenta and may destroy fetal blood cells. The resulting anemia can be severe enough to cause fetal death. If the fetus survives, antibodies can cross to the baby during birth, causing jaundice and other symptoms shortly after birth.
RISK INCREASES WITH
Each pregnancy after the first involving different blood types.
Previous blood transfusions. These might have contained unidentified, incompatible blood types.
PREVENTIVE MEASURES
Obtain prenatal care throughout pregnancy. Medical supervision early in pregnancy is essential to determine the risk of Rh incompatibility.
Special anti-Rh gamma globulin (RhoGAM) is given to the unsensitized mother at 28 weeks gestation and within 72 hours after delivery, miscarriage, ectopic pregnancy, or abortion. This prevents formation of antibodies that might affect future infants. In women who are already producing antibodies, there is no benefit to using RhoGAM.
Amniocentesis beginning at 16 to 20 weeks if indicated by elevated antibody titers in the mother. Amniocentesis can be used in specialized laboratories to determine fetal blood type. There is risk involved with amniocentesis for the mixing of fetal and mother blood, miscarriage and injury to the fetus.
Cordocentesis (percutaneous umbilical blood sampling or PUBS) may be recommended, despite some risks, to determine fetal blood type and the degree of anemia.
EXPECTED OUTCOME
With prompt recognition of the disorder, damage to the infant can be prevented with exchange transfusions. These transfusions are administered directly into fetal circulation by PUBS.
POSSIBLE COMPLICATIONS
Permanent neurological damage, such as cerebral palsy or hearing loss (rare).
Blood transfusion reaction.
TREATMENT
GENERAL MEASURES
Blood tests to type the mother's, father's and infant's blood, measure the mother's Rh-positive antibodies, and detect hemolytic anemia in the infant's blood.
Amniocentesis (a small amount of amniotic fluid is withdrawn from the amniotic sac that surrounds the unborn child in the uterus for a diagnostic procedure).
Intrauterine blood transfusions (sometimes).
Transfusion to completely exchange the infant's blood after birth.
Hospitalization. The newborn child will remain in the hospital up to 2 weeks after an exchange transfusion.
If you have Rh-negative blood type, tell any health care provider or midwife who treats you. Make sure this information is in your medical records. Wear a medical alert type bracelet or pendant identifying your medical condition.
MEDICATION
If you are pregnant and have Rh-negative blood type, and you are unsensitized (no antibodies), you may be prescribed an anti-Rh gamma globulin injection (RhoGAM) at 28 weeks and again within 72 hours after delivery or termination of pregnancy for any reason. You may have an antibody titer drawn during pregnancy to see if you are producing anti-Rh antibodies. There has been concern about mercury (used as a preservative) being used in Rhogam and potential risks involved with mercury. Do research about the pros and cons of using a blood product that uses mercury as a preservative. You do not need RhoGAM if your fetus is Rh-negative. Rhogam is not 100 percent effective. You may still become sensitized even if you use Rhogam.
ACTIVITY
No restrictions.
DIET
The infant may be breast-fed (or bottle-fed) normally.
For the mother during pregnancy:
In 'Polly's Birth Book' by Polly Block, that there are a number of women who had begun their childbearing years Rh- (Rh Negative). When they had continual problems with pregnancies, they began seriously to build their blood and their general health. In each case physicians, not the mothers, discovered a change in their RH status. They were now RH+ (Rh Positive). The doctors were astounded and called for additional tests and reports. They could not understand why a mother who had been RH- for years was now RH+. These women all shared something in common. In each instance, these women had concentrated on purifying their blood by changing their diets so they had exceptional nutritional intake.
Eat fruit for one week.
Eat fresh, raw, homegrown foods or organic foods. Eat foods that built blood: Grape juice, molasses, beets, etc.
Eliminate sugar, coffee and caffeine, alcohol, and soft drinks, as well as white flour, prepared foods and refined products from your diet.
Use herbal lower bowel tonic and had occasional enemas or colonics to keep their bowels evacuated thoroughly during body cleanses.
Use herbs to cleanse and build the blood. Several of these mothers gave Periwinkle special credit.
- Drink plenty of cups of Red Raspberry Leaf tea.
- A tea made from red clover blossoms, chaparral, licorice root, poke root, peach bark, Oregon grape root, stillingia, cascara sagrada, sarsparilla, prickly ash bark, burdock root and buckthorn bark.
- A few capsules daily of: goldenseal root, blessed thistle, cayenne, cramp bark, false unicorn root, ginger, red raspberry leaves, squaw vine and uva ursi. (NuFem 100 capsules Ingredients: Golden Seal Root, Blessed Thistle Herb, Cayenne Pepper, Cramp Bark, False Unicorn Root, Ginger Root, Red Raspberry Leaves, Squawvine Herb and Uva Ursi Leaves in a 100% pure vegetable based capsule).
- And a few capsules daily of: black cohosh, sarsparilla, ginseng, licorice, false unicorn, holy thistle and squawvine. ( Changease 100 capsules or extract Ingredients: Black Cohosh, Sarsparilla, Ginseng, Licorice, False Unicorn, Holy Thistle and Squaw Vine. All encapsulated products are in a pure 100% vegetable based capsule).
Take 1,000 mg of vitamin C with bioflavonoids daily for the last 30 weeks of your pregnancy (Susan Weed's Wise Woman Herbal for the Childbearing Year).
Quality nutritional supplements and bulk herbs are available through HerbalRemedies.com and Mountain Rose Herbs. Click on the links below to visit these providers.
Mountain Rose Bulk Herbs
Mountain Rose Aromatherapy Oils
Click Here To Visit Herbal Remedies Product Page
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Your baby has any of the following symptoms after the birth (whether at home, birth center or in the hospital):
- Fever.
- Jaundice (within 24 hours).
- Poor appetite or poor weight gain.
- Excessive crying that does not stop when the baby is held.
LINKS
Jennifer's Birth Story
Kim's Information About Rh- Mothers and Rhogam
Rhogam information for law suits: warnings about mercury content in Rhogam
Mandatory Rhogam shots: Question everything
Rh- Information and alternative methods of building your blood
RhoGam Safety Letter by FDA
MoonDragon's Pregnancy Information: Rhogam Question to MoonDragon.org
