Rh Factor And Rhogam Shots

Terms like Rh-positive and Rh-negative sound more of mathematical terms than baby biology and mathematics is the last thing you, with your fuddled pregnancy brain, could want to think about. However, these terms have nothing to do with mathematics in any way; rather, they refer to specific biological aspects. As such, it is important to understand what Rh factor is and what it is all about.

What is Rh-Factor?

Just like there are many different blood groups like type A, AB and so on, there also is the Rh factor. This factor is, in specifics, a protein that is present on the surface of a healthy persons red blood cells. It is interesting to note that this factor can either be present or absent in a person. As such, people who have it are Rh positive while those who do not have it are Rh negative.

The Rh factor is hereditary – meaning that it is inherited by children from their parent’s genes. If the father is Rh+ and the mother is Rh-, there is very high chance the fetus will inherit its Rh genes from the father and could therefore be either Rh+ or Rh-. However, in the event both the father and mother are Rh negative, then the baby will end up being Rh negative.

Rh-Factor and Pregnancy

When it comes to pregnancy, the Rh factor plays a major role and could cause problems if you, the mother, are Rh negative, and the fetus is Rh positive. This scenario is normally referred to as Rh incompatibility and often the problems will not be noticed during the first pregnancy but rather in subsequent pregnancies.

When the mother and the fetus are incompatible that is, the mother is negative while the fetus is Rh positive, then a couple of things start taking place. When the mother’s blood mixes with that of her Rh+ fetus, it causes her Rh negative to create antibodies against the fetus’ Rh factor. The antibodies then attack the fetus’s Rh factor as though it were something harmful. Such a person one who’s Rh negative and whose system can create Rh antibodies – is referred to as Rh Sensitized.

How Rh Sensitization Occurs

When pregnant, the mother and the fetus don’t share their blood systems. Nevertheless, a small amount of the fetus’ blood can or may cross the mother’s placenta and into her system – this happens during either pregnancy, labor or birth. It also may happen if a mother who is Rh negative experiences the following at any point during her pregnancy:

  • Bleeding during pregnancy
  • Amniocentesis
  • The manual rotation of the baby during a breech presentation just before labor
  • Chorionic villus sampling
  • Blunt trauma to the mother’s abdomen during her pregnancy

Often, during a Rh- woman’s first pregnancy of a Rh+ fetus, the problems are never too serious as the baby is born before her body can develop many antibodies. However, if no preventive treatment is undertaken during the woman’s first pregnancy, there is a very high risk that her later pregnancy with an Rh+ fetus could put the baby at risk of being attacked by Rh disease.

Rh Sensitization And Its Effect On The Fetus

Rh sensitization can be harmful to the fetus; especially when Rh antibodies from a Rh sensitized woman cross into the placenta and starts attacking the blood of the fetus. These antibodies start destroying some of the fetus’ red blood cells causing hemolytic anemia where the red blood cells are getting destroyed faster than they can be replaced by the body. Severe hemolytic anemia can be fatal to the developing fetus.

Rh Sensitization Testing And Prevention

If you are Rh negative and are pregnant with a Rh positive baby, it is important that you get antibody screen blood test to see if your body is developing or has developed any antibodies to Rh+ blood and how many of these antibodies have been made. It is advisable that this test be done during the first trimester and once again during the 28th week of pregnancy.

The great thing is that, if detected early enough, Rh sensitization can be prevented. As such, if you are negative, then an Rhlg or Rh immunoglobulin shot is administered. When this immunoglobulin is administered to a nonsensitized Rh- person, it goes to target any Rh+ cells in their bloodstream, preventing the production of any Rh antibodies. When administered in a woman who’s Rh-negative and has not yet made any antibodies against the Rh+ factor, the immunoglobulin could help prevent against hemolytic anemia in the fetus later in the pregnancy.

Rhogam Shots and Your Pregnancy

Rhogam is an Rh Immunoglobulin vaccine designed to help keep the blood of Rh negative women from attacking their Rh positive fetuses. However, this vaccine-like compound can only be effective if the mother has not yet become Rh sensitized. That is why it is important that the mother have her blood tested early in time to find out if she is Rh negative and if her system is developing any antibodies against her fetus.

The best time to do this is during the first trimester of your first pregnancy. It is during this time, that any abnormalities can easily be identified. Once identified, the Rhogam shot will be administered during the 28th week of your pregnancy and once again within 72 hours after you have given birth. This ensures that all subsequent pregnancies will be safe as the first and that you do not grow Rh sensitized. Other times the Rhogam shot will be administered is after chorionic villus sampling or amniocentesis, miscarriage, ectopic pregnancy, or abortion.

PUPPPs: an Overview of Pruritic Urticarial Papules of Pregnancy

A woman’s immune system is suppressed during pregnancy, meaning she has a greater risk of developing benign conditions that would otherwise not manifest. Small rashes, allergies, and eczema can all flare up during pregnancy. These small, but only slightly bothersome conditions can most likely be handled with home remedies. There are some, however, that can be more troublesome, and may require closer attention. One of these conditions is called pruritic urticarial papules and plaques of pregnancy (PUPPP). Pruritic describes an intense itching sensation, or a strong urge to scratch. Urticarial papules are red bumps, hives, and sometimes lesions that appear on the surface of the skin. When a large area of the skin is covered with urticarial papules, it’s called a plaque.

PUPPPs is a benign chronic rash that occurs in 1 in 200 pregnancies, about 0.5% of all pregnancies. It is the most commonly diagnosed dermatological condition related to pregnancy. PUPPPs is not dangerous to mom or the unborn baby. PUPPPs occurs in the late third trimester, most often just a few weeks before delivery. It also occurs more often in women carrying their first baby or multiples. The PUPPPs rash can be difficult to diagnose. There is no test that can be done to confirm PUPPPs, although it might be tested in order to rule out more dangerous conditions.

Symptoms

Not every rash that occurs late in pregnancy can be diagnosed as PUPPPs. PUPPPs is characterized to be a rash consisting of light to deep red hives and lesions causing intense itching. PUPPPs appears on the areas of the skin that have been under the most stress and have more striations. It starts low on the abdomen, often inside existing stretch marks. It then spreads across the entire lower belly and around to the buttocks, and down to the upper thighs. It can also appear on the arms, legs, armpits, chest, and neck. The rash coalesces, meaning if it disappears it does not reappear on another area. It spreads out or shrinks as a whole. The rash rarely appears on the hands, feet, or face. In almost all cases of PUPPPs, the rash abates or is completely gone within two weeks of delivery. In a small number of cases, the rash can appear for the first time in the days directly following delivery, and last into the first few weeks postpartum. The hives, rash, and lesions are not likely to leave scarring, but may take several weeks to fade after the initial itching subsides.
While the condition does not pose a threat to the mother or unborn baby, the severe itching can be extremely disruptive, even painful, for those women suffering from it. PUPPPs can look very similar to another pregnancy related dermatological condition called pemphigoid gestationis. Pemphigoid gestationis is an autoimmune condition that can have harmful consequences for the unborn baby. It is therefore crucial for any rash seemingly similar to a PUPPPs presentation to be examined, and perhaps biopsied in order to rule out the potentially more harmful condition pemphigoid gestationis.

Causes

The exact cause of PUPPPs is unknown. Studies have eliminated the possible connection to carrying a male baby or fetal weight gain. PUPPPs is not associated with pregnancy hormones. PUPPPs occurs in 0.05% of pregnancies, about 1 in 200 total pregnancies. Women most likely to be diagnosed with PUPPPs are pregnant for the first time, or carrying multiples. One study suggests that excessive maternal weight gain is associated with the onset of the condition. Recurrence of PUPPPs is rare, meaning if it’s diagnosed during a first time pregnancy, it is not likely to happen in any future pregnancies.

Treatment

The most success in treating the rash is the application of topical ointments or creams containing a mild steroid. One study conducted by the Department of Dermatology at Columbia University found success treating PUPPPs with a 0.05% fluticasone lotion. Fluticasone is a mild corticosteroid. There were 57 patients in the study, all were pregnant women late in their third trimesters and suffering from PUPPPs. They applied the lotion to affected areas two times a day. The fluticasone lotion helped immensely to reduce the rash and relieve itching. Any steroids, topical or oral, should be discussed with a physician before starting.
Eliminating dairy from the diet can reduce the symptoms of the rash, although that has not been scientifically proven. Since the extreme itching and urge to scratch can disrupt sleeping patterns, oral antihistamines can aid in sleeping, but are considered not very helpful with relieving the actual itching sensations. General remedies for itching can help keep that particular symptom at bay for a short time. These include oatmeal bath soaks, applying coconut oil, and unscented moisturizers. These can reduce the appearance of the lesions and relieve itching. The hives do not scar on their own, although it may take several weeks for their appearance to fade. In order to prevent scarring, it is crucial to refrain from scratching the rash. Furthermore, scratching can create micro tears in the skin, allowing bacteria to invade and cause infection.

Management

There is no direct cure for the condition. This means that only the symptoms can be managed through mild or topical treatments. Since PUPPPs is a pregnancy related condition, the rash subsides or disappears completely shortly after the delivery of the baby. Other things that can be done to give temporary relief for general itching include bathing in soft water, avoiding bathing in hot water, washing with unscented bath products, pat or air drying the skin, drinking plenty of water, cold compresses on rash areas, and avoiding excessive sweating.

Although PUPPPs can be extremely uncomfortable, it is important to remember that the condition is benign. It is not dangerous to have, and does not pose a threat to mom or unborn baby. If it is experienced during the first pregnancy, it’s very unlikely to happen again in future pregnancies. There are several home remedies that relieve the intense itching, and a few options available through a doctor to help reduce the rash. General prognosis for PUPPPs is very good, it recedes completely within weeks of delivery and doesn’t leave scarring.