Rh disease occurs when an Rh-negative mother and her husband conceive an Rh positive child. When a few of the baby's Rh positive red blood cells cross into the mother's system via the placenta, either through a fall or accident, an amniocentesis, during a miscarriage, elective abortion, or ectopic (tubular) pregnancy, or after delivery when the placenta is removed, the mother's immune system identifies these Rh positive fetal RBCs as foreign and sets out to immediately destroy them, as well as form long-term antibodies to fight them off at a later time.
If you are an Rh negative woman and you are carrying an Rh positive child during your first pregnancy, the chance of becoming sensitized and causing a problem for the baby is small. If the baby's RBCs pass into the mother's system, her body responds by producing antibodies and she becomes "Rh sensitized." As a result, she will always carry these antibodies in her immune system.
Early in pregnancy a standard group of routine prenatal blood tests are done on nearly all pregnant women. Included in this panel of tests is a blood test to determine your blood type (A, B, or O), your Rh status (positive or negative), and your antibody status. In this simple test, the laboratory is looking for a reaction by specific antibodies that might be present in your blood, specifically, if you have an Rh antibody, and if you do, what is the antibody exactly. If the antibody screen is negative then you are considered "unsensitized." If it is positive, the lab goes on to identify the exact antibody. The risks for potential problems with this pregnancy are then addressed. Prevention is only necessary and effective if you are Rh negative with an antibody screen that is negative.
In this circumstance, sensitization can be prevented by giving the Rh negative woman an injection of Rh immunoglobulin (RhoGAM™) during and after pregnancy. Rh immunoglobulin is an antibody derived from human blood products, which is injected into one of your muscles, usually an arm or buttock. With this specific antibody, your immune system is fooled into thinking it has already made these antibodies and blocks your immune system from producing any more.
So if you are Rh negative with a negative antibody screen, it is considered standard prenatal care to give you injections of RhoGAM™ to prevent Rh sensitization. You will receive two shots, one at twenty-eight weeks gestation and then again within seventy-two hours after the birth of your baby, if your baby is Rh positive. This method of prevention seems to block sensitization for a period of about twelve weeks, which is why you need two injections during the course of your pregnancy. For this reason, it is important that RhoGAM™ be given with all of your pregnancies, even those which may result in miscarriage, elective termination, or an ectopic pregnancy.
RhoGAM™ is given any time the placenta is disturbed due to an accident or blow to the stomach, which could cause the placenta to pull away from the wall of the uterus. It should also be given after an amniocentesis and after an episode of vaginal bleeding.