Hello doctor, My sister-in-law is six weeks pregnant. Five years ago, she gave birth to a boy who was healthy and is to this day. She is Rh negative and her husband is Rh positive. At the birth of her first child, she was advised that she should not breastfeed the baby and so she did not. I did not understand why. She went to the doctor's appointment a couple of days ago she was advised to terminate the pregnancy. I do not understand the details but they said she has an antibody titer level of 100. I have read a good deal on this and now assume she has Rhesus D alloimmunization (although I am unsure of the quality of the lab results). She has never had anti-D immune globulin. I do not know the quality of the medical attention she is getting and would like to help. Can you please tell me what information I should gather to be able to get an opinion on this? She would very much like not to terminate the pregnancy if that is a reasonable thing for her to do.
Hi. Some more points regarding her situation and previous history are needed actually. She is Rh negative and husband Rh-positive but is it known that he is homozygous or heterozygous for anti-D allele? If homozygous, then the baby would be Rh-negative and more chances of complications but if heterozygous, need more chorionic villus sampling or amniocentesis to know child's blood group. Was the previous child's blood group known? Was it positive or negative? Antibody titer 1:4 considered as alloimmunized where as needed monthly antibody titer whereas antibody titer of 1:16 need strict monitoring. The baby has more chances of having fetal anemia, hydrops fetalis, jaundice, etc., and need twice weekly titer. Any chronic health issue she has? If yes, have a complete check-up and treatment for that as well. It is better to discuss the case with titer report and repeat it again from authentic laboratory so that you can have more genuine results. Serial scan and antibody titer in pregnancy with anti-D advised in 28 and 32 weeks and in case of fetomaternal hemorrhage as well is advised actually. The serial scan also gives an idea about fetal condition more clearly in the second trimester.