MoonDragon's Pregnancy Information
Rhesus (Rh) Hemolytic Disease of the Newborn (HDN)
For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.
Rh Isoimmunization - Erythroblastosis Fetalis Description Signs & Symptoms Causes Risk Factors Preventive Measures Expected Outcome Possible Complications Conventional Medical Treatment Guidelines & Management Medication Activity Recommendations & Restrictions Diet & Nutrition Notify Your Health Care Provider Rh Isoimmunization-Related Supplement Products
RH ISOIMMUNIZATION - ERYTHROBLASOSIS FETALIS DESCRIPTION
Rh Isoimmunization occurs when there is an incompatibility between an infant's rhesus factor blood type and that of its mother, resulting in hemolytic disease of the fetus and newborn (HDN, HDFN). destruction of the infant's red blood cells (hemolytic anemia) during pregnancy and after birth by antibodies from its mother's blood. This disease is an alloimmune condition that developos in a fetus when the IgG molecules (one of the five main types of antibodies) produced by the mother pass through the placenta. Among these antibodies are some which attack the red blood cells in the fetal circulation, the red cells are broken down and the fetus can developo reticulocytosis and anemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood and so these forms of the disease can be called erythroblastosis fetalis.
HEMOLYTIC DISEASE OF THE FETUS & NEWBORN
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 an invasive medical procedure, such as amniocentesis, or during delivery, a small amount of the infant's blood is absorbed by the mother through the placenta 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 cross the placenta and may potentially destroy fetal blood cells of any future rh-positive babies. The resulting hemolytic anemia can be severe enough to cause fetal death while inside the uterus. If the fetus survives, antibodies can cross to the baby during birth, causing jaundice and other symptoms shortly after birth.
Rhesus (Rh) hemolytic disease of the newborn (HDN) is a serious, often fatal disease caused by incompatibility between an Rh-negative mother and her Rh-positive fetus.[1-3] If prophylaxis were not available today - as was the situation prior to the introduction of RhoGAM Brand in 1968 - then the following statistics[1,2,4,5] would be true:
- 13 to 14 percent of Rh-negative expectant mothers could become alloimmunized during an Rh-incompatible pregnancy.
- 25 percent of fetuses would need immediate treatment to avoid kernicterus (a form of brain damage caused by excessive jaundice and associated symptoms).
- 25 percent of fetuses would develop hydrops fetalis and die.
- Only 50 percent of fetuses would be mildly affected and not require treatment.
Alloimmunization: An Rh-negative woman may become alloimmunized to the D antigen present on fetal red blood cells (RBCs) during the first Rh-incompatible pregnancy. Alloimmunization can occur during a number of situations, including fetal-maternal hemorrhage, bleeding that occurs during normal delivery, ectopic pregnancies, spontaneous or induced abortions, and abdominal trauma. The first pregnancy is rarely affected because the number of Rh antibodies produced by the mother during primary immunization is low and the antibodies are usually IgM in nature. Rh Hemolytic Disease of the Newborn (HDN): Pathogenesis.
Anamnestic response: When the mother is exposed to D-positive fetal RBCs during a subsequent Rh-incompatible pregnancy, the mother mounts an anamnestic, or secondary, immune response to the fetus' RBCs. A large number of IgG-class Rh antibodies are produced. The IgG antibodies cross the placenta and make fetal red cells susceptible to destruction. The fetal RBCs are then destroyed by the fetal immune system. Anemia develops in the fetus with a concomitant increase in unconjugated bilirubin. The anemia and unconjugated bilirubin levels can lead to a number of conditions.
The clinical manifestations of Rh HDN can range from very mild to death in utero or shortly after delivery.[1,2,4,5]
The fetal liver and spleen enlarge as they attempt to produce more fetal RBCs in response to hemolysis. Nucleated RBCs can be observed in the fetal blood due to the release of immature erythyrocytes (this gave rise to the name, erythroblastosis fetalis).
In the worst cases, severe anemia leads to hydrops fetalis, which is characterized by severe edema that develops sometime after 18 weeks gestation. Hydrops fetalis develops secondary to congestive heart failure and liver failure due to extreme hepatosplenomegaly (enlargement of the liver and spleen) and portal hypertension.
After delivery, jaundice may occur due to an increase in RBCs. The infant lacks sufficient amounts of glucuronidase and albumin to process the bilirubin, which was metabolized by the placenta and the mother before birth.
Kernicterus or bilirubin encephalopathy can occur as levels of unconjugated bilirubin increase. The bilirubin can accumulate in neuronal tissues resulting in central nervous system damage and developmental problems that can include:
- Dental enamel dysplasia.
- High-frequency nerve deafness.
- Athetoid cerebral palsy.
- Mental retardation, pulmonary hemorrhage.
1. Rubin E, Farber JL. Development and genetic diseases. In: Pathology. 2nd ed. Philadelphia, Pa: JB Lippincott Company;1994:256.
2. Prasad AS. Acquired hemolytic anemias. In: Bick RL, ed. Hematology: Clinical and Laboratory Practice. Vol 1. St. Louis, Mo: Mosby-Yearbook, Inc.;1993:391-396.
3. Turgeon ML. Hemoyltic disease of the newborn. In: Turgeon ML, ed. Fundamentals of Immunohematology: Theory and Technique. Philadelphia,PA: Lea & Febiger;1989:321-343.
4. Bowman JM. Antenatal suppression of Rh alloimmunization. Clin Obstet Gynecol. 1991;34:296-303.
5. Freda VJ, Gorman JG, Pollack W, et al. Prevention of Rh hemolytic disease - ten years clinical experience with Rh immune globulin. N Engl J Med. 1975;292:1014-1016.
MoonDragon's Articles: Rh Isoimmunization
MoonDragon's Pregnancy Information: Rh Isoimmunization - RhoGam Question
FREQUENT SIGNS & SYMPTOMS
Signs during pregnancy:
- Decreased fetal growth.
- Decreased fetal movement.
Signs in a newborn:
- 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.
- Lack of normal movement.
- Poor reflex response.
Hemolysis leads to elevated bilirubin levels. After delivery bilirubin is no longer cleared (via the placenta) from the neonate's blood and the symptoms of jaundice (yellowish skin and yellow discoloration of the whites of the eyes) increase within 24 hours after birth. Like any other severe neonatal jaundice, there is the possiblity of acute or chronic kernicterus (a bilirubin-induced brain dysfunction).
Bilirubin is a highly neurotoxic substance that may become elevated in the serum, a condition known as hyperbilirubinemia. Hyperbilirubinemia may cause bilirubin to accumulate in the gray matter of the central nervous system, potentially causing irreversible neurological damage. Depending on the level of exposure, the effects range from clinically unnoticeable to severe brain damage and even death. Neonates are especially vulnerable to hyperbilirubinemia-induced neurological damage and therefore must be carefully monitored for alterations in their serum bilirubin levels.
Profound anemia can cause high-output heart failure, with pallor (paleness of the skin), enlarged liver and/or spleen, generalized swelling and respiratory distress. The prenatal manifestations are known as hydrops fetalis (a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments, such as the abdomen and other areas). In severe forms this can include petechiae (small red or purple spots (less than 3 mm in size) caused by broken capillary blood vessels - minor hemorrhages) and purpura (red or purple discolorations on the skin (measuring 3 to 10 mm) that do not blanch on applying pressure and caused by bleeding underneath the skin). The infant may be stillborn or die shortly after birth.
Antibodies are produced when the body is exposed to an antigen foreign to the make-up of the body. If a mother is exposed to a foreign antigen and produces IgG (as opposed to IgM which does not cross the placenta), the IgG will target the antigen, if present in the fetus, and may affect it in utero and persist after delivery. The three most common models in which a woman becomes sensitized toward (i.e., produces IgG antibodies against) a particular antigen are:
RHESUS (RhD) SENSITIZATION
- Fetal-maternal hemorrhage can occur due to abortion, childbirth, ruptures in the placenta during pregnancy, or medical procedures carried out during pregnancy that breach the uterine wall. In subsequent pregnancies, if there is a similar incompatibility in the fetus, these antibodies are then able to cross the placenta into the fetal bloodstream to attach to the red blood cells and cause hemolysis. In other words, if a mother has anti-RhD (D being the major Rhesus antigen) IgG antibodies as a result of previously carrying a RhD-positive fetus, this antibody will only affect a fetus with RhD-positive blood.
- The woman may have received a therapeutic blood transfusion. ABO blood group system and the D antigen of the Rhesus blood group system typing are routine prior to transfusion. Suggestions have been made that women of child bearing age or young girls should not be given a transfusion with Rhc-positive blood or Kell-positive blood to avoid possible sensitization, but this would strain the resources of blood transfusion services, and it is currently considered uneconomical to screen for these blood groups. HDFN can also be caused by antibodies to a variety of other blood group system antigens, but Kell and Rh are the most frequently encountered.
- The third sensitization model can occur in women of blood type O. The immune response to A and B antigens, that are widespread in the environment, usually leads to the production of IgM anti-A and IgM anti-B antibodies early in life. On rare occasions, IgG antibodies are produced. In contrast, Rhesus antibodies are generally not produced from exposure to environmental antigens.
If you are an Rh-Positive (Rh+) woman, there is no concern for you regardless of your partners blood factor. Just as there are different major blood groups, such as A and B type blood, there is also an Rh factor - a type of protein on the red blood cells. Most people have this factor and are Rh+ (Rh-positive); others do not have it and are Rh- (Rh-negative). A simple lab test quickly determines whether you are Rh+ or Rh-. The Rh factor does not affect a person's general health. It can cause problems during pregnancy, however. Being Rh negative simply means your blood does not insert the allele that instructs your body to put the RH positive antigen on your red cells. It takes two Rh negative alleles to make an Rh negative person, but only at least one to make an Rh positive person. Therefore there are a greater number of Rh positives. It is or soon will be possible to determine by laboratory test whether an Rh positive person has two Rh positive alleles or only one.
MoonDragon's Lab Information: ABO-Rh Blood Typing - EldonCard Method
MoonDragon's Lab Information: Blood Typing & Incompatibilities: ABO-Rh Blood Typing
The Rh factor causes problems when an Rh- mother and an Rh+ father conceive an Rh+ child. The mother can become sensitized. This means she produces antibodies to fight the Rh factor as if it were a harmful substance. These antibodies then attack the fetal Rh+ blood cells, in a subsequent Rh+ pregnancy. During pregnancy, although mother and baby have separate blood systems, blood from the baby can cross the placenta into the mother's system. This mixing of blood is most likely to occur if:
1. Someone pulls on the umbilical cord while delivering the placenta.
2. Clamps the cord early, before pulsations have ceased, leading to a backup of fetal blood into the mother.
3. Mixing of the blood can occur during amniocentesis or other intrusive tests.
Once formed, these antibodies do not disappear. In a first pregnancy with an Rh+ baby, the baby is usually delivered before the mother develops significant amounts of antibodies. In a second pregnancy with an Rh+ baby, the antibodies are more likely to cause hemolytic disease in the baby. This condition usually becomes worse in later pregnancies. It takes time for an immune response to be mounted, as the number of children increases; the chances of damage go up. Sensitization can also occur if an Rh- woman has:
1. Had a previous miscarriage.
2. Induced abortion or ectopic pregnancy.
Hemolytic disease can cause babies to develop jaundice, heart failure, anemia, brain damage or fetal death. In some babies it shows up in utero, in others it is characterized by jaundice in the first 24 hours and usually requires a transfusion and other intensive care measures.
These risk factors may increase the chances of complications associated with rh-isoimmunization and Rh-hemolytic disease of the newborn.
Each pregnancy after the first involving different blood types. Previous blood transfusions. These might have contained unidentified, incompatible blood types.
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 most cases. 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.
HEMOLYTIC DISEASE PREVENTION
Hemolytic disease can for the most part be prevented if the Rh- mother has not already made antibodies against the Rh factor from an earlier pregnancy or blood transfusion. RhoGam is a blood product that can help prevent sensitization of an Rh-negative mother. It suppresses her ability to respond to Rh-positive red cells. RhoGAM is not helpful if the mother is already sensitized. It is not 100 percent effective in all cases.
Interesting to note, midwives and home-birth health care providers, who delay clamping the cord until the blood has stopped pulsating, report an almost zero incidence of Rh problems.
A blood test, called an antibody screen, can show if an Rh-negative woman has developed antibodies to Rh-positive blood.
Once a woman develops antibodies, RhoGAM treatment does not help. An Rh sensitized mother can be checked during her pregnancy to see if the baby is developing hemolytic disease. Delivery may be followed by a type of transfusion for the baby that will replace the diseased blood cells with healthy blood.
Prior to RhoGAM, somewhere between 10 to 16 percent of Rh-negative women became sensitized to their baby's blood. Traditionally, RhoGam is given within 72 hours of birth. This is a recommendation which arose from the fact that the researchers developing the protocols for giving RhoGAM postpartum used the 72 hour period because of the logistics of drawing blood from volunteers who were newly delivered and usually discharged by 72 hours. Since they had such a high success rate with this particular protocol, this 72-hour limit became sacred. However, immunologists know that immune response is not initiated until fetal cells are identified by the mother's spleen. This process can take weeks. Therefore, you can go past the 72 hours before administrating the RhoGAM vaccine.
RhoGAM is developed by injecting human volunteer donors (Rh-) with the positive Rh factor, then drawing their blood once antibodies have been formed. This blood is concentrated into a serum for injection. RhoGAM is a human-blood product and therefore, despite all government reassurances, may contain the AIDS virus. RhoGAM reduces, but does not eliminate the possibility of Rh sensitization.
RhoGAM joins a long list of medical interventions that once were considered to be beyond question but now are suspect. RhoGAM, like immunizations and silver nitrate in the eyes of newborns, has been a form of Holy Water in the Religion of Modern Medicine.
Since 2 percent of Rh- women still become sensitized even with RhoGAM, researchers, seeking to better the percentage, began to give RhoGam at 28 weeks of pregnancy. This is a elatively new procedure.
With prenatal RhoGAM, the future siblings are the ones who may benefit from the treatment, rather than the baby who is subjected to the risk. Tests on babies whose mothers were given RhoGam prenatally imply that the immunoglobulin reaches the baby in measurable amounts. No one knows what the effect might be on an Rh- female baby who later gives birth to Rh+ babies.
Because the baby's blood type is not ordinarily known during pregnancy, the standard of care among United States obstetricians has come to be that all babies of Rh- mothers, regardless of their blood type, are exposed to RhoGAM. This means that approximately 35 percent of babies are needlessly exposed to RhoGAM. Another group of babies needlessly exposed are those who will be their mother's last child. It is only future pregnancies that are affected by the mixing of blood between Rh- mothers and Rh+ babies.
A part that may cause problems, in addition to the AIDS question, is the preservative thimerosol, which is a mercury derivative. Mercury crosses the placental barrier and, within minutes of maternal exposure, the unborn baby receives 30 times the concentration level of the mother. (Note: RhoGAM is now available in mercury-free formulations in the US. If you are getting RhoGAM treatment, be sure to have your health care provider or midwife check to see if the RhoGAM is the thimerosol-free formulation.)
MoonDragon's Health & Wellness: Mercury Toxicity
The use of RhoGAM during pregnancy may be dangerous to the baby. Some mothers after receiving prenatal RhoGAM have had their babies die within a week of having the vaccine.
Due to the 30 micrograms of thimerosal in each RhoGAM shot, fetuses receive this high dose. Children who have high mercury levels (due to thimerosal in vaccinations) are at special risk. Children have undeveloped blood brain barriers and much of the mercury goes to the brain, resulting in significant adverse neurological effects, including autism, persuasive developmental disorders (PDD), Asperger's syndrome, obsessive compulsive disorder (OCD), dyslexia, ADD/ADHD, learning disabilities, childhood depression.
Source: Rhogam & Pregnancy Stealth Mercury Assault, By Stephen C. Marini, D.C., PhC>
INTERESTING RH BLOOD FACTS
The woman is blamed for Rh incompatibility, and professionals refer to "Rh negative women and their babies", never to "Rh positive men and their babies", even though it is just as much the father's genes as the mothers that is the cause of the problem. It is simply a case of ignorance akin to those who blame the woman for having a daughter instead of a son, when it is the man who determines the actual gender of the offspring.
Rh-negative blood is good, so is Rh-positive blood, just like being blood type A or type B or type O. They are just different, as different as two different species of humans. That is why they do not "mix".
Rh-negative blood carries special antibodies that others do not. Some blood banks "buy" this blood on a regular basis; it has special antibodies that are used to help some very physically ill people.
85 percent of world population is Rh positive, leaving only 15 percent Rh negative.
More people who are Rh-negative have roots in Scotland, Ireland, and Peru-Basque peoples.
In the 90's, in Germany and also in Ireland, thousands of pregnant women of Rh-negative factor were given RhoGAM; this shot however carried a horrible disease, hepatitis. This happened two times, about three years apart. Women and babies became ill. Time went on and eventually these women went to court. It was learned and proven that it was known in advance and proven in court, that the blood they received was tainted with hepatitis. This makes sense since RhoGAM is a blood-based product made from human blood.
According to conventional medical theory and treatment, 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.
Permanent neurological damage, such as cerebral palsy or hearing loss (rare). Blood transfusion reaction.
Complications of HDN could include kernicterus, hepatosplenomegaly, inspissated (thickened or dried) bile syndrome and/or greenish staining of the teeth, hemolytic anemia and damage to the liver due to excess bilirubin. Similar conditions include acquired hemolytic anemia, congenital toxoplasma and syphilis infection, congenital obstruction of the bile duct and cytomegalovirus infection.
CONVENTIONAL MEDICAL TREATMENT GUIDELINES
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.
- ABO hemolytic disease of the newborn can range from mild to severe, but generally it is a mild disease.
- Anti-A antibodies
- Anti-B antibodies
- Rhesus D hemolytic disease of the newborn (often called Rh disease) is the most common form of severe HDN. The disease varies from mild to severe.
- Rhesus E hemolytic disease of the newborn is a mild condition.
- Rhesus c hemolytic disease of the newborn can range from a mild to severe disease - is the third most common form of severe HDN.
- Rhesus e hemolytic disease of the newborn - rare.
- Rhesus C hemolytic disease of the newborn - rare.
- Antibody combinations (i.e. anti-Rhc and anti-RhE antibodies occurring together) - can be severe.
- Anti-Kell hemolytic disease of the newborn.
- Anti-K 1 antibodies - disease ranges from mild to severe - over half of the cases are caused by multiple blood transfusions - is the second most common form of severe HDN
- Anti-K 2, anti-K 3 and anti-K 4 antibodies - rare.
Other blood group antibodies (Kidd, Lewis, Duffy, MN, P and others).
The diagnosis of HDN is based on history and laboratory findings:
Blood tests done on the newborn baby:
- Biochemistry tests for jaundice.
- Peripheral blood morphology shows increased reticulocytes. Erythroblasts (also known as nucleated red blood cells) occur in moderate and severe disease.
- Positive direct Coombs test (might be negative after fetal interuterine blood transfusion).
Blood tests done on the mother:
- Positive indirect Coombs test.
MEDICAL TREATMENT OPTIONS
Before birth, options for treatment include intrauterine transfusion or early induction of labor when pulmonary maturity has been attained, fetal distress is present, or 35 to 37 weeks of gestation have passed. The mother may also undergo plasma exchange to reduce the circulating levels of antibody by as much as 75 percent.
After birth, treatment depends on the severity of the condition, but could include temperature stabilization and monitoring, phototherapy, transfusion with compatible packed red blood, exchange transfusion with a blood type compatible with both the infant and the mother, sodium bicarbonate for correction of acidosis and/or assisted ventilation.
Rhesus-negative mothers who have had a pregnancy who are pregnant with a rhesus-positive infant are offered Rh immune globulin (RhIG) at 28 weeks during pregnancy, at 34 weeks, and within 72 hours after delivery to prevent sensitization to the D antigen. It works by binding any fetal red cells with the D antigen before the mother is able to produce an immune response and form anti-D IgG. A drawback to pre-partum administration of RhIG is that it causes a positive antibody screen when the mother is tested, which can be difficult to distinguish from natural immunological responses that result in antibody production.
PREGNANCY - RH-IMMUNE GLOBULIN (RhIG) MANAGEMENT
If father of the baby or donor is Rh positive or unknown, the patient is a candidate for RhoGAM prophylaxis in the following cases:
Micro RhoGAM - Should only be given if a pregnancy terminates before 13 weeks (TAB, SAB, Ectopic, Molar) Full dose RhoGAM is given:
- Threatened abortion at any stage with confirmed pregnancy.
- Abortion, ectopic, or molar pregnancy at or beyond 13 weeks.
- Genetic amniocentesis.
- Unexplained first, second or third trimester bleeding.
- Abdominal trauma 2nd or 3rd trimester.
- Third trimester amniocentesis.
*If amnio repeated in greater than 21 days another full dose of RhIg should be given.
*If amnio is performed and delivery is anticipated within 48 hours, administration of RhIg can be with held until after delivery and determination of the newborn to be Rh positive can be made.
- Antepartum prophylaxis at 28 weeks.
- External version.
- Post dates pregnancy beyond 40 weeks.
- 12 weeks since last RhoGAM, repeat antibody screen and administer RhIg.
*if delivery occurs within 21 days of administration of RhIg and examination of maternal blood sample does not reveal an excessive amount of fetal RBC's additional RhIg is not needed.
If delivery is anticipated within 48 hours, administration of RhIg can be withheld until after delivery and determination of the newborn to be Rh positive can be made.
If patient elects not to receive RhoGAM at 28 weeks, repeat antibody screen every 4 weeks until delivered.>
If at any time the patient's antibody screen is positive obtain MD consultation.
Obtain cord blood for blood type, Rh and direct coombs.
Postpartum (if Newborn is Rh-Pos). If newborn is Rh positive, have RhIg given to the mother within 72 hours of delivery. (Current recommendations is one vial if fetal RBC's less than 25 ml and two vials if 25 to 50 ml and so forth.)
If direct coombs is positive obtain cord bilirubin.
If mother is a RhoGAM candidate and is also Rubella Non-Immune, administer the RhoGAM and hold the rubella vaccine until 3 months postpartum.
Testing the baby's Rh factor is now available prenatally. For about 38 percent of women, this means they would not need the 28-week RhoGAM shot. RhD Genotyping from ARUP Laboratories has some information about this testing. Your health care provider may order this test through his or her lab facility. You will want to check with your health insurance first to make sure they cover the test fee.
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.
RHOGAM PRODUCT INFORMATION
RhoGAM Ultra-Filtered PLUS is a sterile solution that contains antibodies to the Rh factor. The antibodies in RhoGAM Brand are derived from human plasma that has been carefully screened and processed for purity. When injected, the RhoGAM Brand antibodies circulate in the Rh-negative mother's bloodstream and prevent her immune system from making the sensitized antibodies that would threaten a baby with Rh-positive blood.
The mechanism of RhoGAM in preventing sensitization may be due to:
Clearance of antigen from the mother's system.
Blocking of the antigen brought about by the attachment of RhoGAM to the antigenic sites of fetal cells in the mother's circulation, or some sort of more central type (systemic) inhibition of antibody formation.
The 72 hour rule emerged from the original trials with Rh IG. Since it can take several weeks for the body to mount a full antibody response, it is possible that RhoGAM could be given much later than 72 hours after an exposure and remain effective. However, the parameters for how long it would be possible to wait are not known. Obviously, if it is known that an exposure has occurred, then it would seem prudent to give the RhoGAM as soon as possible. But in terms of your question, it is probable that if an unknown exposure occurred more than 72 hours prior to giving the injection at 28 weeks, and antibodies have not yet developed, then potentially that RhoGAM would offer protection against the development of those antibodies.
INDICATIONS & USAGE
PREGNANCY AND OTHER OBSTETRICAL CONDITIONS: RhoGAM Brand is indicated for administration to Rh-negative women not previously sensitized to the Rho(D) factor, unless the father or baby are conclusively Rh-negative. Appropriate uses include:
- Delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby.
- Antepartum prophylaxis at 26 to 28 weeks of gestation.
- Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g.,version) or abdominal trauma.
- Actual or threatened pregnancy loss at any stage of gestation.
- Ectopic pregnancy.
TRANSFUSION OF RH-INCOMPATIBLE BLOOD OR BLOOD PRODUCTS: RhoGAM Brand may also be used for the prevention of Rh immunization in any Rh-negative person after incompatible transfusion of Rh-positive blood or blood products (e.g., red blood cells, platelet concentrates, granulocyte concentrates).
PRECISE DOSING INSTRUCTIONS
Available in two dosage strengths:
- RhoGAM 300 µg - For antenatal and postpartum use, second- and third-trimester pregnancy terminations, or transplacental hemorrhage [1-3].
- MICRhoGAM 50 µg - For use immediately after first-trimester pregnancy termination [3,4].
WHEN TO ADMINISTER RhoGAM® Brand
- At 28 weeks gestation [5-8].
- Within 72 hours postpartum .
- Following spontaneous or induced termination .
- Following any event that could lead to transplacental hemorrhage (such as amniocentesis, chorionic villus sampling (CVS), percutaneous umbilical blood sampling (PUBS), or abdominal trauma) .
HOW OFTEN TO ADMINISTER RhoGAM Brand
RhoGAM Brand should be administered in 12-week intervals . Severe systemic allergic reactions are extremely rare. .
IMPORTANT RhoGAM SAFETY INFORMATION
RhoGAM and MICRhoGAM Ultra-Filtered PLUS Rho(D) Immune Globulin (Human) are made from human plasma. Since all plasma-derived products are made from human blood, they may carry a risk of transmitting infectious agents, e.g., viruses, and theoretically the Creutzfeldt-Jakob disease (CJD) agent. RhoGAM® and MICRhoGAM® are intended for maternal administration. Do not inject the newborn infant. Local adverse reactions may include redness, swelling, and mild pain at the site of injection and a small number of patients have noted a slight elevation in temperature. Patients should be observed for at least 20 minutes after administration. Hypersensitivity reactions include hives, generalized urticaria, tightness of the chest, wheezing, hypotension and anaphylaxis. RhoGAM® and MICRhoGAM® contain a small quantity of IgA and physicians must weigh the benefit against the potential risks of hypersensitivity reactions. Patients who receive RhoGAM® and MICRhoGAM® for Rh-incompatible transfusion should be monitored by clinical and laboratory means due to the risk of a hemolytic reaction.
The use of RhoGAM Brand and MICRhoGAM Brand is contraindicated in Rh-positive individuals.
The Official RhoGAM Site
1. RhoGAM® Ultra-Filtered PLUS Package Insert. Ortho Clinical Diagnostics.
2. RhoGAM® Ultra-Filtered Marketing Authorization Application: Part IB1. Summary of Product Characteristics. Ortho Clinical Diagnostics. November 2000.
3. Pollack W, Ascari WQ, Kochesky RJ, et al. Studies on Rh prophylaxis. 1. Relationship between doses of anti-Rh and size of antigenic stimulus. Transfusion. 1971;11:333-339.
4. Frigolette FD Jr, ed. Antepartum administration of Rh immune globulin: a guide to office procedure. Raritan, NJ: Ortho-Diagnostic Systems, Inc. 1983.
5. Bowman JM, Chown B, Lewis M, et al. Rh isoimmunization during pregnancy: antenatal prophylaxis. Can Med Assoc J. 1978;118:623-627.
6. Bowman JM, Pollock JM. Antenatal prophylaxis of Rh isoimmunization: 28-weeks gestation service program. Can Med Assoc J. 1978;118:627-630.
7. Baskett TF, Parsons ML. Prevention of Rh(D) alloimmunization: a cost-benefit analysis. Can Med Assoc J. 1990;142;337-339.
8. Bowman JM. Antenatal suppression of Rh alloimmunization. Clin Obstet Gynecol. 1991;34:296-303.
9. Mintz PD. Rh Immune Globulin. In: Mintz PD, ed. Transfusion Therapy: Clinical Principles and Practice, 2nd Edition. Bethesda, MD: AABB Press; 2005.
10. Freda VJ, Gorman JG, Pollack W, et al. Prevention of Rh hemolytic disease - ten years clinical experience with Rh immune globulin. N Engl J Med. 1975;292:1014-1016.
11. Prevention of Rh D Alloimmunization. ACOG Practice Bulletin. Number 4, May 1999. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists.
ACTIVITY & RESTRICTIONS
DIET & NUTRITION
FOR INFANT - AFTER BIRTH
The infant may be breast-fed (or bottle-fed) normally.
FOR MOTHER - DURING PREGNANCY
According to 'Polly's Birth Book' by Polly Block, that there are a number of women who had begun their childbearing years 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-positive. The doctors were astounded and called for additional tests and reports. They could not understand why a mother who had been RH-negative for years was now RH-positive. 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.
POLLY BLOCK'S BLOOD CLEANSING PROCEDURE RECOMMENDATIONS
Eat fruit for one week. This will initiate the cleansing process.
Eat fresh, raw fruits and vegetables, homegrown foods or organic foods. Eat foods that build blood such as pure Grape juice, Molasses, Beets, and others.
Change the diet. Eliminate sugar, coffee and caffeine, alcohol, and soft drinks (sodas), as well as white flour, prepared, processed foods and refined products from your diet.
Use herbal Colon Cleanses for a lower bowel tonic and occasional enemas or colonics to keep 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. Raspberry Leaf tea has been used for centuries as a folk medicine to treat canker sores, cold sores, and gingivitis in persons of all ages and anemia, leg cramps, diarrhea, and morning sickness in pregnant women, and as a uterine relaxant. Commentators frequently state that recent scientific research found no benefit in raspberry tea for expectant mothers, but this is not correct. The study published in the Journal of Midwifery and Women's Health in 2001 found that women who drank raspberry leaf tea had shorter labor, and fewer of their babies were delivered by forceps. The other study, published in the Australian College of Midwives Journal, cited in The Natural Pharmacist as saying there was "no" benefit to the herb for pregnant women, actually stated: "The findings also suggest ingestion of the drug might decrease the likelihood of pre and post-term gestation. An unexpected finding in this study seems to indicate that women who ingest raspberry leaf might be less likely to receive an artificial rupture of their membranes, or require a cesarean section, forceps or vacuum birth than the women in the control group." In other words, scientific studies show that drinking raspberry tea actually is beneficial during pregnancy.
A tea made from Red Clover Blossoms, Chaparral, Licorice Root, Poke Root, Peach Bark, Oregon Grape Root, Stillingia, Cascara Sagrada, Sarsaparilla, Prickly Ash Bark, Burdock Root and Buckthorn Bark.
DELICIOUS RED CLOVER TEA
Red Clover Blossoms Lemon Honey Fresh Mint Leaves & Dandelion Leaves
Put the fresh or dried blossoms and leaves, with or without the mint and dandelion, into a 2-cup earthenware teapot. Fill teapot with boiling water, cover, and infuse for 5 to 10 minutes over very low heat. Strain into a hot cup, add a twist of lemon and sweeten with honey.
A few capsules daily of: Goldenseal Root, Blessed Thistle, Cayenne, Cramp Bark, False Unicorn Root, Ginger, Red Raspberry Leaves, Squaw Vine and Uva Ursi.
And a few capsules daily of: Black Cohosh, Sarsparilla, Ginseng, Licorice, and Milk Thistle.
Hormonal Changease (Changease 100) capsules or extract by Dr. Christophers Original Formulas contains a blend of Black Cohosh, Sarsparilla, Ginseng, Licorice, False Unicorn Root, Blessed (Holy) Thistle, and Squaw Vine. For Milk Production: Dr. Christopher reminded us that it requires a certain balance of hormones - estrogens and progesterones - to produce milk. If a woman does not seem to be making enough milk, she should balance up her hormones by taking a few capsules of this formula. For Rebuilding Weak and Malfunctioning Areas: These are natural herbal foods that are needed by both men and women at all ages. Being "natural" herbs, the human body can accept, assimilate and use those materials that are needed to produce estrogens and other hormones naturally. This formula will assist in rebuilding the weak malfunctioning areas and help keep the organs healthy so they can supply the proper amounts of hormones and estrogens themselves. Herbs are a natural food, so they do not have "side effects" and "after effects" as are so evident in man-made and synthetic drugs. Whenever malfunction shows in either woman or man, in the reproductive areas, it is good to use the two formulas together, i.e., Female Reproductive and Hormonal Changease and for women and Dr. Christopher's Male Urinary Tract and Hormonal Changease for men. For Youth, Expecting Mothers and Those in Menopause: This combination, called Hormonal Changease, helps youths going into puberty, expecting mothers whose hormones sometimes cause problems (one husband says that when his wife is pregnant her "hormones are raging"), women going through the change of life and men, too. Take 2 capsules 3 times a day, or as directed by a health care professional. Store in a cool, dry place. Warning: Do not use during pregnancy, or while nursing, except as directed by your health care professional.
Dr. Christophers Original Formulas - Female Reproduction Formula (NuFem 100) Capsules or Extract with Goldenseal Root, Blessed (Holy) Thistle Herb, Cayenne Pepper, Cramp Bark, False Unicorn Root, Ginger Root, Red Raspberry Leaves, Squaw Vine Herb and Uva Ursi Leaves. Used for the female reproductive system. As a dietary supplement, take two capsules three times a day, or as directed by your health care professional.
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).
It is not known how long it took for this change to occur using the above procedures.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
Your baby has any of the following symptoms after the birth (whether at home, birth center or in the hospital):
- Jaundice (within 24 hours).
- Poor appetite or poor weight gain.
- Excessive crying that does not stop when the baby is held.
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
MoonDragon's Birthing Guidelines: Rh Negative Mothers & Blood Types
MoonDragon's Lab Information: ABO-Rh Blood Typing - EldonCard Method
MoonDragon's Lab Information: Blood Typing & Incompatibilities: ABO-Rh Blood Typing
MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
MoonDragon's Pregnancy Information Index
MoonDragon's Womens Health Pregnancy Information Index
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Information Index
RH-ISOIMMUNE-RELATED NUTRITIONAL SUPPLEMENTS & PRODUCTS
Beets Herbal Products Bioflavonoids Supplement Products Black Cohosh Herbal Products Blessed Thistle Herbal Products Brewers Nutritional Yeast Products Buckthorn Herbal Products Burdock Herbal Products Cascara Sagrada Herbal Products Cayenne Herbal Products Chaparral Herbal Products Colon Cleanse Supplement Products Cramp Bark Herbal Products Dandelion Herbal Products False Unicorn Herbal Products Female Reproduction Formula Products Ginger Herbal Products Ginseng Herbal Products Goldenseal Herbal Products
Honey Products Hormonal Changease Products Licorice Herbal Products Milk Thistle Herbal Products Molasses Products Oregon Grape Herbal Products Peach Bark Herbal Products Peppermint Herbal Products Periwinkle Herbal Products Poke Root Herbal Products Prickly Ash Herbal Products Red Clover Herbal Products Red Raspberry Herbal Products Sarsaparilla Herbal Products Squaw Vine Herbal Products Stillingia Herbal Products Uva Ursi Herbal Products Vitamin C Supplement Products
QUALITY SUPPLIES & PRODUCTS
FEMALE REPRODUCTIVE FORMULA PRODUCTS
Dr. Christophers Original Formulas - Female Reproduction Formula (NuFem 100) Capsules or Extract with Goldenseal Root, Blessed Thistle Herb, Cayenne Pepper, Cramp Bark, False Unicorn Root, Ginger Root, Red Raspberry Leaves, Squawvine Herb and Uva Ursi Leaves. Used for the female reproductive system. As a dietary supplement, take two capsules three times a day, or as directed by your health care professional.
HerbsPro: Nu Fem Powder, Dr. Christophers Formulas, 4 oz. (104593)
HerbsPro: Female Reproductive Formula, Dr. Christophers Formulas, 100 VCaps (39831)
Amazon: Female Reproductive Formula, Nu Fem, Dr. Christopher's Formula Products
Nutrition Basics: Hormone Support Information
HORMONAL CHANGESE SUPPLEMENT PRODUCTS
Hormonal Changease (Changease 100) capsules or extract by Dr. Christophers Original Formulas contains a blend of Black cohosh, sarsaparilla, ginseng, licorice, false unicorn, holy thistle, and squaw vine. For Milk Production: Dr. Christopher reminded us that it requires a certain balance of hormones - estrogens and progesterones - to produce milk. If a woman does not seem to be making enough milk, she should balance up her hormones by taking a few capsules of this formula. For Rebuilding Weak and Malfunctioning Areas: These are natural herbal foods that are needed by both men and women at all ages. Being "natural" herbs, the human body can accept, assimilate and use those materials that are needed to produce estrogens and other hormones naturally. This formula will assist in rebuilding the weak malfunctioning areas and help keep the organs healthy so they can supply the proper amounts of hormones and estrogens themselves. Herbs are a natural food, so they do not have "side effects" and "after effects" as are so evident in man-made and synthetic drugs. Whenever malfunction shows in either woman or man, in the reproductive areas, it is good to use the two formulas together, i.e., Female Reproductive and Hormonal Changease and for women and Dr. Christopher's Male Urinary Tract and Hormonal Changease for men. For Youth, Expecting Mothers and Those in Menopause: This combination, called Hormonal Changease, helps youths going into puberty, expecting mothers whose hormones sometimes cause problems (one husband says that when his wife is pregnant her "hormones are raging"), women going through the change of life and men, too. Take 2 capsules 3 times a day, or as directed by a health care professional. Store in a cool, dry place. Warning: Do not use during pregnancy, or while nursing, except as directed by your health care professional.
HerbsPro: Hormonal Changease Extract, Dr. Christophers Formulas, 2 fl. oz. (39837)
HerbsPro: Hormonal Changease Formula, Dr. Christophers Formulas, 100 VCaps (39836)
HerbsPro: Changease Powder, Dr. Christophers Formulas, 8 oz. (104594)
Amazon: Changease Products
CHANGEASE TABLETS, 100 VCaps, 450 mg
Amazon: Hormonal Changease Tablet Products
Amazon: Hormonal Changease, Dr Christopher's Formulas, 450 mg, 100 VCaps
Amazon: Hormonal Changease, Dr Christopher's Formulas, 450 mg, 100 VCaps
Amazon: Hormonal Changease, Dr Christopher's Formulas, 450 mg, 100 VCaps
CHANGEASE LIQUID, 2 fl. oz.
Amazon: Hormonal Changease Liquid Products
Amazon: Hormonal Changese Liquid, Dr. Christopher, 2 fl. oz.
Amazon: Hormonal Changese Liquid, Dr. Christopher, 2 fl. oz.
CHANGEASE POWDER, 8 oz.
Amazon: Changease Powder, Christophers Original Formula Products
Nutrition Basics: Hormone Support Information
AROMATHERAPY: ESSENTIAL OILS DESCRIPTIONS & USES
Allspice Leaf Oil Angelica Oil Anise Oil Baobab Oil Basil Oil Bay Laurel Oil Bay Oil Benzoin Oil Bergamot Oil Black Pepper Oil Chamomile (German) Oil Cajuput Oil Calamus Oil Camphor (White) Oil Caraway Oil Cardamom Oil Carrot Seed Oil Catnip Oil Cedarwood Oil Chamomile Oil Cinnamon Oil Citronella Oil Clary-Sage Oil Clove Oil Coriander Oil Cypress Oil Dill Oil Eucalyptus Oil Fennel Oil Fir Needle Oil Frankincense Oil Geranium Oil German Chamomile Oil Ginger Oil Grapefruit Oil Helichrysum Oil Hyssop Oil Iris-Root Oil Jasmine Oil Juniper Oil Labdanum Oil Lavender Oil Lemon-Balm Oil Lemongrass Oil Lemon Oil Lime Oil Longleaf-Pine Oil Mandarin Oil Marjoram Oil Mimosa Oil Myrrh Oil Myrtle Oil Neroli Oil Niaouli Oil Nutmeg Oil Orange Oil Oregano Oil Palmarosa Oil Patchouli Oil Peppermint Oil Peru-Balsam Oil Petitgrain Oil Pine-Long Leaf Oil Pine-Needle Oil Pine-Swiss Oil Rosemary Oil Rose Oil Rosewood Oil Sage Oil Sandalwood Oil Savory Oil Spearmint Oil Spikenard Oil Swiss-Pine Oil Tangerine Oil Tea-Tree Oil Thyme Oil Vanilla Oil Verbena Oil Vetiver Oil Violet Oil White-Camphor Oil Yarrow Oil Ylang-Ylang Oil Aromatherapy
Healing Baths For Colds
Using Essential Oils
AROMATHERAPY: HERBAL & CARRIER OILS DESCRIPTIONS & USES
Almond, Sweet Oil Apricot Kernel Oil Argan Oil Arnica Oil Avocado Oil Baobab Oil Black Cumin Oil Black Currant Oil Black Seed Oil Borage Seed Oil Calendula Oil Camelina Oil Castor Oil Coconut Oil Comfrey Oil Evening Primrose Oil Flaxseed Oil Grapeseed Oil Hazelnut Oil Hemp Seed Oil Jojoba Oil Kukui Nut Oil Macadamia Nut Oil Meadowfoam Seed Oil Mullein Oil Neem Oil Olive Oil Palm Oil Plantain Oil Plum Kernel Oil Poke Root Oil Pomegranate Seed Oil Pumpkin Seed Oil Rosehip Seed Oil Safflower Oil Sea Buckthorn Oil Sesame Seed Oil Shea Nut Oil Soybean Oil St. Johns Wort Oil Sunflower Oil Tamanu Oil Vitamin E Oil Wheat Germ Oil
HELPFUL RELATED MOONDRAGON NUTRITION BASICS LINKS
MoonDragon's Nutrition Basics Index MoonDragon's Nutrition Basics: Amino Acids Index MoonDragon's Nutrition Basics: Antioxidants Index MoonDragon's Nutrition Basics: Enzymes Information MoonDragon's Nutrition Basics: Herbs Index MoonDragon's Nutrition Basics: Homeopathics Index MoonDragon's Nutrition Basics: Hydrosols Index MoonDragon's Nutrition Basics: Minerals Index MoonDragon's Nutrition Basics: Mineral Introduction MoonDragon's Nutrition Basics: Dietary & Cosmetic Supplements Index MoonDragon's Nutrition Basics: Dietary Supplements Introduction MoonDragon's Nutrition Basics: Specialty Supplements MoonDragon's Nutrition Basics: Vitamins Index MoonDragon's Nutrition Basics: Vitamins Introduction
NUTRITION BASICS ARTICLES
MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
RELATED MOONDRAGON HEALTH LINKS & INFORMATION
MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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