When we need to call in the RhoGAM shots?
Unbelievable or not, there are instances that maternal system rejects the growing baby inside of her is known as the hemolytic disease of the fetus and newborn (HDFN). This happens because of three reasons. First is when the mother is an Rh negative and the baby is Rh positive. It is basically like the mother is not carrying an antigen, or a molecule in this case, that the baby is carrying so maternal immune response is elicited.
Second is when there is a blood group incompatibility, that is, when mother is a type O and the baby is either type A, or B. And third, is when it is due to other antibodies reasons. In short, the immune system of the mother (or the blood type of the mother) detects the fetal blood as not part of her and rejects it causing general fetal red blood cell destruction, then anemia, and in most cases death of the developing fetus. To prevent this devastating event from happening, clinicians will have to call in the shots, and by that, I mean the Rho (D) human immunoglobulins injections or better known by the brand name RhoGam.
What is with the RhoGam?
RhoGam is a prescribed medication that is injected through the muscles to specifically prevent antibodies of the mother from attacking the fetal circulation, and subsequent rejection of the developing fetus. In a normal pregnancy, during the first three months, about 0.1 ml of fetal blood can already be detected in the mother’s system. As the pregnancy continues, the amount of the fetal blood increases and can be seen in 12% to 45% of women. At the time a mother delivers, 50% of women can already have the fetal blood in the system.
However, the major sensitizing event can happen at the end of the pregnancy when there is separation of the placenta during delivery. So, for this reason, though RhoGAM can be given antenatally (with close supervision), it is usually given within 72 hours of delivery when there is the possibility of maternal blood mixing with the fetal blood and causing severe blood destruction on the newborn after delivery. Or it can be given, when necessary, for up to 28 days after delivery. When given during pregnancy, it is usually recommended to have it from the 28th week onwards, the time when fetal blood is known if it is Rh negative or positive. There is the lower dose of the brand RhoGAM, and it is the MicRhoGam which is used in certain clinical situations.
Side effects of a RhoGAM Shot
Side effects of the vaccine are always expected just like any other medications injected into the body. These include signs of anaphylactic reactions such as difficulty breathing, skin itchiness, swelling of face, lips, tongue or throat, fever, chills, or shaking, sudden weight gain and associated with swelling in hands, feet, or ankles, and back pains. It is very, very important to always seek medical attention when these things occur.
There are also less serious effects of the vaccine, but still medical attention has to be considered. So important safety information should always be present. If a mother has known allergic reactions to any medications containing human immunoglobulins, the clinician has to be aware. If the woman has recent history of vaccination containing live virus, RhoGAM may prevent some vaccines from working. And lastly, if the woman has an IgA deficiency the clinician has to know. There might be a risk of allergic reaction in IgA deficient women because the vaccine contains a small amount of IgA.
Current Issues on RhoGam administration.
There are however current issues surrounding the administration of RhoGam especially during the course of pregnancy. The accepted preparation of the vaccine contains a necessary amount of mercury, known as thimerosal. It is believed that because of this mercuric content, administration of such can have neurological consequences on the developing fetus. In one article regarding mercury and RhoGam shots, hair analysis from babies whose mothers were injected with the vaccine showed traces of mercury.
Although this has appeared in some online articles, other articles in contrast to such belief said that administration of the vaccine, specifically during pregnancy does not hold any adverse effects on the fetus. However, in addition to that, the guidelines for the use of the anti-D immunoglobulins as prophylaxis in UK have been changed. It mentioned that if the mother experiences threatened miscarriage less than 12 weeks of gestation, then the vaccine is not already recommended. However, according to the drug literature, MICRhoGAM, the lesser dose, can be used for Rh negative women who experienced an actual or threatened termination of pregnancy at or up to 12 weeks of pregnancy.
Since its introduction in the 1970s the vaccine has fairly contributed to the decrease in fetal mortality and morbidity. Although, just like any other vaccines or medications, it is subjected to personal views and opinions, the important thing is, whatever medical conditions a woman has especially during pregnancy, management of the condition should be between a clinician and the woman to avoid any unlikely events to happen. Also equipping oneself with valid information regarding any medications and vaccines are very helpful.
Author: Sarah Catina RN