BackTable / OBGYN / Podcast / Transcript #45

Podcast Transcript: RhoGAM’s Role in Pregnancy: Facts & Controversies

with Dr. Matt Reeves

This episode of BackTable OBGYN features Dr. Matt Reeves, a seasoned OBGYN and CEO/Founder of the DuPont Clinic, and host Dr. Amy Park as they discuss the use of Rh immune globulin (RhoGAM) in pregnancy. You can read the full transcript below and listen to this episode here on BackTable.com.

(1) History & Development of RhoGAM

(2) Understanding Rh Alloimmunization & RhoGAM's Role

(3) RhoGAM Origins & Supply

(4) RhoGAM Utilization: Controversy & Debate

(5) Changing RhoGAM Practice Patterns in the US & Abroad

(6) Predictions & Perspectives on the Future of RhoGAM

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RhoGAM’s Role in Pregnancy: Facts & Controversies with Dr. Matt Reeves on the BackTable OBGYN Podcast)

Ep 45 RhoGAM’s Role in Pregnancy: Facts & Controversies with Dr. Matt Reeves

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[Dr. Amy Park]
I just wanted to open up this episode and say thank you so much to Matt Reeves for joining us on another episode. I've known Matt for a long time. Dr. Reeves is the chief executive officer and founder of the DuPont Clinic, a center that provides patient-centered abortion care in all trimesters. With a team at DuPont Clinic, Dr. Reeves has worked to re-envision the patient experience, create a new patient flow without a waiting room, develop new shortened protocols for later abortion, improve nurse-administered moderate sedation techniques, and introduce new GYN instruments.

After completing undergrad at UPenn, it sounds like you attended Harvard Med School, completed OBGYN residency at UCSF, where you also did the fellowship in clinical ultrasound, and then the fellowship in family planning at the University of Pittsburgh, and also completed an advanced training in clinical research program. At Pitt, you also got the MPH studying statistics, research methods, and decision modeling techniques, and then joined the medical faculty at Pitt for three years with an NIH-funded K Award.

After one year at CONRAD, a USAID-funded product development division of Eastern Virginia Medical School, Dr. Reeves served as the chief medical officer of WomenCare Global, where his work focused on expanding use of manual uterine aspiration and introducing mifepristone and levonorgestrel implants to new markets. Prior to his current position, he was the medical director of the National Abortion Federation, where he worked to improve the quality of abortion care across North and South America.

Lots of appointments, including at the ACOG, Society of Family Planning, Clinical Associate Professor of OBGYN at GW, Stanford, and Johns Hopkins Bloomberg School of Public Health, as well as serving on national committees at the Society of Family Planning and ACOG, and the Clinical Affairs Committee at SFP, and the Clinical Practice Guidelines Committee.

(1) History & Development of RhoGAM

[Dr. Amy Park]
I am so happy I get to talk to you about this RhoGAM, because actually this all started because you and I were having dinner, and then you described RhoGAM to me as “shady man serum”, and I was like, ""Wait, wait. Tell me more. Tell me more."" Of course, you - being the polymath, international man of mystery that you are - was telling me about how you went to a conference that's just all on RhoGAM, and I was like, ""Tell me more."" Tell me how you ended up attending this conference. What is RhoGAM? Why do we care?

[Dr. Matt Reeves]
It started with a meeting at [unintelligible 00:03:32] Health Project, where they invited about 12 of us to discuss the issues around Rh-negativity in pregnancy, preventing alloimmunization, and what RhoGAM is. One of the post-docs, a pathologist who was around when they were developing RhoGAM was there and told us the whole story of how it developed, including where the 72 hours came from. Which of course is purely practical because they were pathologists. They did not work on the weekends, so if someone needed RhoGAM, they needed a window long enough so they could wait. That's where 72 hours came from.

[Dr. Amy Park]
Wait, what do you mean 72 hours? What does 72 hours have to do with anything?

[Dr. Matt Reeves]
Oh, you have to give RhoGAM within 72 hours of delivery.

[Dr. Amy Park]
Oh, I didn't realize that. Oh, okay.

[Dr. Matt Reeves]
Yes, the 72 hours was because they didn't want to come in on the weekend.

[Dr. Amy Park]
Tell me this story because I tried looking up a PubMed search on RhoGAM and there's a really old obstetrics and gynecology article from 1991 that is not available. If you read the abstract, it's super breathless in terms of the description. What did this guy tell you?

[Dr. Matt Reeves]
A lot of interesting things. I went into this meeting not really knowing anything in detail about RhoGAM, but what he described was that when they were developing it, they discovered that you couldn't just take serum from one man. Basically, they sensitized men by injecting them with Rh-positive blood, Rh-negative men injecting them with Rh-positive blood and they get sensitized and they could collect the antibodies from these men and then look at their neutralizing abilities against Rh-positive red blood cells.

Basically, what they found was that one-man serum wouldn't work, that you had to pool the serum of multiple men. The idea was that you basically needed to cover the Rh antigen so that all the potential epitopes on it were blocked. You couldn't just have it blocked behind one spot on the RhoGAM, you had to basically cover the thing with antibodies so that it prevented the exposed person from getting any exposure to the Rh protein, Rh antigen, and so that they had to pool it.

Because of that reason, you can't make it in a hybridoma model where you have a cell line that secretes one antibody because you need lots and lots and lots of antibody types. You can't have one antibody, you can't have two, you have to have, they didn't know exactly how many, but enough to really cover the Rh antigen. Basically, to make it, you have to take the serum from many men and then condense it down into units."

(2) Understanding Rh Alloimmunization & RhoGAM's Role

[Dr. Amy Park]
Back up for a second and why do we even care about this? For people who may not know.

[Dr. Matt Reeves]
Imagine most know about Rh alloimmunization in women. It's when an Rh-negative woman has an Rh-positive fetus, and during the birth process, she is exposed to some of the blood from the fetus and will develop antibodies. In the course of that, those antibodies stay. In the next pregnancy, some of those antibodies, because the antibodies from the mom cross the placenta actively, they will enter the fetus and attack the fetus's Rh-positive red blood cells in the next pregnancy.

Generally, in the second pregnancy, it's not a big deal, but with enough pregnancies and with enough blood exposure, so the amount of blood exposure varies in each pregnancy, so the sensitization can vary, but eventually an Rh-negative woman who has enough Rh-positive babies will typically become sensitized. The result when she has enough sensitization is that her antibodies are essentially attacking the fetus's red blood cells, and those cells get cleared and the fetus can develop anemia, profound anemia, and even die.

RhoGAM was developed to essentially help through a passive immunization sort of way clear the red blood cells from the patient's bloodstream so that she isn't exposed to those Rh-positive red blood cells. This is very effective, and it works great. The thing they discovered, which was a bit controversial apparently at the time, was that traditionally you give two doses, one at 28 weeks and then one right after delivery. When they started with the right after delivery thing, everyone thought that would do it. It turns out it didn't, and they had to add this dose at 28 weeks, which apparently at the time was very controversial.

This would have been in the '50s and '60s, because those antibodies, the ones that are injected, will cross the placenta as well. It's not enough to do any harm to the fetus, but it was still controversial at the time. Giving that 28-week dose is what made it not quite 100%, but very close to 100% effective. We've been doing that. We've been doing a dose at 28 weeks and a dose at 40 weeks ever since. The thing that was never really studied in any systematic way was, this is great for continuing pregnancies, but what about miscarriages? What about abortion? What about ectopic? Basically, we just went crazy giving RhoGAM to everybody for everything when there really wasn't any evidence except for those doses.

(3) RhoGAM Origins & Supply

[Dr. Amy Park]
Can we go back to what you're saying about RhoGAM development? Because what I could tell was it was developed by Columbia University researchers, it sounds like, and there were pathologists and I'm sure some heme people involved. Then it sounds like prisoners from Sing Sing were the initial Rh-sensitized individuals. Can you tell me more about that?

[Dr. Matt Reeves]
I wish I could. I can't tell you a lot more. I imagine they buried that history. I imagine they were "volunteers." I'm not sure how that happened or transpired.

[Dr. Amy Park]
They would not pass the CITI Program training?

[Dr. Matt Reeves]
Yes. The research ethics training had not been developed. Yes. Most of the initial volunteers for donating the serum were Rh-negative prisoners who were sensitized and then their blood collected.

[Dr. Amy Park]
Then do you happen to know about like, how did they scale this up? I read some article a couple of years ago that this one man who's like in his 70s was the main supplier of all the RhoGAM. Is that true?

[Dr. Matt Reeves]
I don't know a whole lot about the supply line for RhoGAM. I do know that it is limited and becoming more limited, not surprisingly, this isn't a popular line of work. There's more and more people, there are more and more people who need it and not an increasing supply. This raised the issue of do we really need to use it for all these things, the miscarriages, the ectopics?

(4) RhoGAM Utilization: Controversy & Debate

[Dr. Amy Park]
What was the impetus for this invitation for you and these other 11 at the meeting?

[Dr. Matt Reeves]
It was really about abortion, and do we need to be giving it for every six-week abortion? Because it is becoming more expensive and more limited. Is there even any evidence that we need it? Turns out there really wasn't much, almost none.

[Dr. Amy Park]
Yes, because the full dose at 28 and term is like 300 mics, and then microgram is like, I can't even remember, it's like a hundred or something or 75 mics.

[Dr. Matt Reeves]
50.

[Dr. Amy Park]
50 mics.

[Dr. Matt Reeves]
I'm pretty sure. It's one fifth.

[Dr. Amy Park]
Then it's like total guesswork, probably. There's all sorts of questions about-- I know a couple, you know Hilary Gammill. I remember she was doing some work on like chimeric cells circulating throughout the maternal circulation and then how we were using the KB, which is a terrible task, to try and quantify fetal RBCs and the maternal bloodstream, but I don't even know, it sounds like the technology for that has really improved lately.

[Dr. Matt Reeves]
Yes. Using flow cytometry, we're able to get much better estimates of how many fetal red blood cells are actually in maternal circulation. That's where some of the newer data comes in that how many fetal red blood cells were introduced by abortion procedures. It turns out basically none. For most of the women, the difference between before and after was zero and the amount of circulating fetal.

[Dr. Amy Park]
That was for first trimester or second trimester, or how far along were we talking?

[Dr. Matt Reeves]
With the flow cytometry, there were two studies in the first trimester and neither showed any increase in fetal red blood cell exposure after the abortion.

[Dr. Amy Park]
Then our practice has always been Rh-negative moms, any kind of vaginal bleeding, first trimester abortion, any kind of vaginal bleeding at all, an Rh-negative mom, we'd be giving RhoGAM. How is this data going to change that kind of practice? We only have first trimester data, but where are we going with the guidelines, and then where do our future thinking?

[Dr. Matt Reeves]
Just to clarify, there was one second trimester study and they used KB testing. Without going into all the methods of the KB test, it does pick up some maternal cells, so it's not perfect, but they did a study using that and found no significant difference before and after surgical abortion, so it's also likely that even in second trimester abortion, the amount of exposure is pretty small. No one's ready to give up RhoGAM for second trimester yet, but for first trimester, the data is compelling enough that the Society of Family Planning has recommended that RhoGAM isn't needed through 12 weeks.

[Dr. Amy Park]
Yes, I think the ACOG is probably working on something. I'm not on the OB side, but I would absolutely think that that is coming down the pike. I saw the JAMA article and our former colleague and friend, Corrie, was instrumental in this research, Corrie Schreiber, who's at Penn.

[Dr. Matt Reeves]
Yes, it was her fellow, Sarah Horvath, who led the research. Yes, it's good research and it's very compelling.

(5) Changing RhoGAM Practice Patterns in the US & Abroad

[Dr. Amy Park]
Then how does the US compare to the other countries in terms of practice patterns and what are they seeing in terms of sequelae?

[Dr. Matt Reeves]
Yes, WHO is already-- and they have a slightly different audience because they're international where often RhoGAM isn't available, but a lot of this becomes very relevant in the US with the changes since the Dobbs decision last year where a lot of women are using mifepristone and misoprostol. One of these studies was medical abortion. Being able to say that you can do mifepristone and misoprostol without needing RhoGAM just makes it a lot easier for folks who may not have access to testing and RhoGAM.

[Dr. Amy Park]
Didn't you tell me that most of the world, nobody else gives RhoGAM?

[Dr. Matt Reeves]
Not the way we do, that's for sure. Yes.

[Dr. Amy Park]
Are they giving it at 28 weeks and at term too?

[Dr. Matt Reeves]
In some places. There are parts of the world where Rh-negativity is fairly common. I have always been taught it was most common in the Basque and Celtic population, which is true if you have a Western European-centric point of view, but it's also even more common in Saudi Arabia and parts of the Horn of Africa around Ethiopia and Somalia, where it can be up to 20% to 30% of the population, and I don't know the data on what their Rh alloimmunization rates are. You also have to keep in mind where we are in terms of average numbers of children per family, per person.

Really the problems with Rh alloimmunization typically don't become severe until the third pregnancy. That's without any RhoGAM at all, and third full-term pregnancy, that's just not that common anymore. Sure, people have a third pregnancy, but not many are having many more than that. Most are having one or two. The demographics of fertility have changed a lot. 100 years ago or even 60 years ago, larger families were much more common, so it's much more important to use RhoGAM to prevent applications and additional pregnancy.

[Dr. Amy Park]
That's such a good point. That did pop into my mind. The average fertility, the median rate in a lot of countries is less than what needs to be, I think it's 2.4 or something in order to replenish the population, but it's super skewed. East Asia, it's like less than two, the US is hovering around two, but in Africa and India and a lot of other places, it's still quite high. I don't know the numbers.

[Dr. Matt Reeves]
Yes. For the US, when you combine the Venn diagram of fewer pregnancies per person and we're already giving a lot of RhoGAM that it becomes less important to give RhoGAM in pregnancies that really are very low risk. That the likelihood of Rh alloimmunization is extremely low. It does happen and it is seen in some. I saw one case in residency and it was a patient who had some sort of trauma, I think a gunshot probably. They were out of Rh-negative blood, so she was going to apparently might've died. They gave her blood, Rh-positive blood in the hope that she was Rh-positive and she wasn't, so she got a full unit of Rh-positive blood and she was sensitized and had alloimmunization with her subsequent pregnancy. Barring that, incidents like that, it's almost unheard of.

[Dr. Amy Park]
Yes, I know. I don't think I saw one case in residency. Yes, that is super interesting. Then you were telling me in Sweden or somewhere in Scandinavia, it's also super rare and they don't routinely give it, right?

[Dr. Matt Reeves]
Yes. That's where the demographics issue comes in. In Sweden, they don't use RhoGAM for first trimester abortion and they have great research databases, so they do these great population level research databases. Several of us went to some researchers and said, "Could we look at this?" Could we look at Rh alloimmunization and who has it and whether they've had medical abortions and does it cause it?
They went and looked at it and basically they found that there are very few abortions because they have great access to contraception, few relative to the US, and their total fertility is so low that there are very few pregnancies after a medical abortion didn't get RhoGAM, too few for them to look at. That's a country of five million people, so there aren't a lot of Rh-negative people who had a medical abortion who then go on to have a live birth. When you combine all those aspects, you get down to very few patients, and I said, "Not enough to look at," because there aren't many pregnancies, aren't many kids being born in that group or any group.

[Dr. Amy Park]
That's super interesting. It sounds like we need to go to Saudi Arabia and the horn of Africa [laughs] and ask what the–

[Dr. Matt Reeves]
They don't use it at all in Ethiopia. I don't know what their Rh alloimmunization rates are. I was in Ethiopia early this year and we talked about it. They said, "No." They said, "Yes, we do see it every now and then," but they couldn't really say whether it was related to the abortions or just lack of RhoGAM generally, so it's not clear, and maybe they'll be able to do some research on it, but we don't have any information there.

[Dr. Amy Park]
That just begs the question, what is our responsibility as OBGYNs in terms of safeguarding individuals versus like a more public health lens on isoimmunization versus the RhoGAM supply and production issues, because I know when we talk about-- I don't know, I'm just going to give an example that came up, like how we screen for endometriosis or whatever, and our Canadian colleagues are like, "Oh, well, we--" They just have a very different viewpoint on it. There are just not enough advanced MIG surgeons to deal with this whole issue, so it's super referred and they just use everything as these very strict public health guidelines. The US, there's guidelines, but it's a little bit more individualized approach, and it seems like RhoGAM is definitely a public health kind of-

[Dr. Matt Reeves]
Yes. Intervention. Yes.

(6) Predictions & Perspectives on the Future of RhoGAM

[Dr. Amy Park]
What is your take? What are your feelings on this? How do you see this story evolving?

[Dr. Matt Reeves]
I think for a long time, it was basically with RhoGAM, the case of the more, the better, but there didn't seem to be any harm to using lots of it, so patient comes in with a little spotting and they're Rh-negative, "Give them RhoGAM." Anything you do that might cause any fetal blood into the maternal circulation, "Give them RhoGAM," and without really evidence to verify that there's actually a need for RhoGAM.

As the supply is decreasing, and the potential benefits are less, because if you only have three pregnancies in your lifetime, and how much you're getting, say the first one you got the full dose of RhoGAM as term, and the second one's a miscarriage at five weeks and you have a uterine aspiration, what's the benefit to you as a patient for that? Presumably you want a third pregnancy. Even more than that, RhoGAM has been routinely administered to women who are at the end of their childbearing who have an abortion. They have absolutely no desire to have a future pregnancy.

Say they're 40, 42 years old, have an unintended pregnancy, their other kids are teenagers. Most abortion providers in the country would almost force that patient to have RhoGAM. It really wasn't even a discussion, and there was no shared decision-making about, "Is it worth it for me to give RhoGAM?" When you throw in there how it's made, I think a lot of patients might think twice about it. It's not an entirely benign substance. It is pooled human product from men, as you pointed out, who maybe aren't in the best circumstances.

[Dr. Amy Park]
I'm sure there's a screen.

[Dr. Matt Reeves]
I don't know how it is now. Back when it was it all the –

[Dr. Amy Park]
I'm sure there's a screen, but we've come a long way from our prison roots. [laughs] If RhoGAM–

[Dr. Matt Reeves]
I don't know who's doing it now, but people are going to take blood products from 100 prisoners at Sing Sing and inject it into you. How do you feel about that?

[Dr. Amy Park]
Oh my God.

[Dr. Matt Reeves]
Regardless of where they're from, they take a pooled product from 100 men and inject it, when you have no desire to have another pregnancy, you're not concerned about future alloimmunization. In the bigger picture, there's a shortage really internationally of this product. I think that shared decision-making and that viewpoint on using what's becoming a scarcer resource has changed how we're using RhoGAM.

[Dr. Amy Park]
Yes, it is interesting, because it never even occurred to me about stewardship of this resource. It's just like giving blood products. Just generally speaking, I remember people just being like, "Let's just give two units," and then we were going by these numbers, like he will go into 10 cardiac patient, whatever. Then I just saw this whole series in JAMA about how restrictive transfusion is better, and they use a cutoff of seven grams per deciliter.

[Dr. Matt Reeves]
That came out when we were in medical school, that study of the 7 versus 10.

[Dr. Amy Park]
Oh really? I didn't even realize that.

[Dr. Matt Reeves]
Yes. It was a randomized trial in the late '90s, early 2000s. Yes. It took a while to get into practice.

[Dr. Amy Park]
Over 20 years later. I went to medical school-

[Dr. Matt Reeves]
Yes, that's typical.

[Dr. Amy Park]
-in 1998 to 2002. Anyway, there's chronic blood shortages. The screening is intensive and I don't know, I didn't even think about it, that moiety must be so big that it just has to be pooled, like you said. I don't know how many people they require, but I've never even seen volunteers for this. Do they use it through the blood bank or how does that work?

[Dr. Matt Reeves]
I really don't know the details of how it's made. I don't know how they recruit people. I guess maybe if you're Rh-negative, you get targeting advertising on Instagram.
[laughter]

[Dr. Amy Park]
Yes. No, that's true. That's true. Then where do you think that in terms of, do you think that with maternal trauma or these other things, we always used to get these patients like car accident, we send a KB, whatever. Is it feasible to do flow cytometry to quantitate these things and have a little bit more precision about titrating RhoGAM dose?

[Dr. Matt Reeves]
Not anytime soon. I know for the studies that Sarah Horvath did with Corrie Schreiber, that they had to set up their own lab protocol. They weren't doing it through the routine hematology lab. They had to set up a whole special area to do their flow cytometry. It was not coming to a lab near you.

[Dr. Amy Park]
Then what do you think is the resistance or the uptake going to be? Because I think there's a lot of–

[Dr. Matt Reeves]
Oh, yes. I think it'll take a long time. In some cases, it's going there quickly. The one area is medical abortion by telemedicine. Using mifepristone and misoprostol via telemedicine, which has just dramatically increased over COVID and with these recent abortion bans in many states. Basically, most of those telemedicine programs have already implemented the SFP guidelines. They aren't doing Rh testing, so they don't even know, so there's not a lot of RhoGAM being used in those. The number of abortions being performed by telemedicine has increased dramatically. In that way, I think the impact has already begun. When it gets to the community level, maybe like the study of the transfusing at 7 versus 10 for ICU patients, that may take 20 years. Hopefully not, but it may take a while before that's really implemented.

[Dr. Amy Park]
You know what's interesting is I think sometimes the supply chain will just force our hands because-

[Dr. Matt Reeves]
Maybe.

[Dr. Amy Park]
-COVID basically made us all adopt telemedicine, and then supply chain issues made us be more green. We couldn't get certain things and you just had to–

[Dr. Matt Reeves]
Like lidocaine for a while, right?

[Dr. Amy Park]
Yes. There's been periodic lidocaine shortages for the last 10 years, I would say. It's fine and then it's not fine and then it's fine again, so we have to be inventive. The Lidojects, we've been using those. I don't know if you've ever tried–

[Dr. Matt Reeves]
The Euroject?

[Dr. Amy Park]
Yes, the Euroject.

[Dr. Matt Reeves]
Yes. Using it for what?

[Dr. Amy Park]
Lidocaine.

[Dr. Matt Reeves]
Injecting it?

[Dr. Amy Park]
Yes, you can eject it.

[Dr. Matt Reeves]
Oh my goodness. Never even occurred to me.

[Dr. Amy Park]
Yes, but it's just a more viscous form. You're using it like for injection?

[Dr. Matt Reeves]
Paracervical block.

[Dr. Amy Park]
Yes, you can use the Lidoject.

[Dr. Matt Reeves]
Really?

[Dr. Amy Park]
It's just a different viscosity. I wouldn't see why you can't. Harder to inject probably, but not by much.

[Dr. Matt Reeves]
It sounds like a good plastic surgery thing, like a filler and a [unintelligible 00:26:47] at the same time. [laughs]

[Dr. Amy Park]
I think it's like the same stuff. It's just thicker, right?

[Dr. Matt Reeves]
I'm not going to try it first.

[Dr. Amy Park]
Okay.

[Dr. Matt Reeves]
Let me know.

[Dr. Amy Park]
Yes, I don't need to do a lot of cervical blocks. Anyway, it's just interesting because I know there's this implementation science and they talk about barriers to evidence-based or implementing evidence-based practices and then also identifying barriers. Then actually, I think a bunch of the different national societies have these Choose Wisely campaigns. I don't know if you've seen them.

[Dr. Matt Reeves]
No.

[Dr. Amy Park]
They're basically like-- once things like RhoGAM are in practice, for instance, it's really hard for people to let it go because they're just used to doing it. It feels like-

[Dr. Matt Reeves]
The right thing, yes.

[Dr. Amy Park]
-the right thing. There's all this data and evidence to do it and that's why we always did it, but there wasn't all this evidence and data to support it. It was just like administering all that oxygen to the neonates or whatever. That took, I don't know, probably 20 years to discontinue as well, once they started studying that. I think there's just a lot of things where it's hard to discontinue, and these Choose Wisely campaigns are just trying to promote conversations between clinicians and patients. It looks like it's the ABIM, but I think that other societies–

[Dr. Matt Reeves]
For shared decision-making.

[Dr. Amy Park]
Yes, shared decision-making, but also just implementing evidence-based practices and avoids unnecessary medical tests, treatments, and procedures. Anyway, yes, they have all sorts of different specialties here. Although I don't see OB-GYN here, but anyway. [laughs]

[Dr. Matt Reeves]
Someday soon.

[Dr. Amy Park]
I'm just looking at this. Anyway, I do appreciate you coming on this podcast though and talking about this because this is a hot topic right now, and I think it's truly right off the presses. I mean, these papers were just published in the last year or so.

[Dr. Matt Reeves]
Yes. The last one in JAMA was last month. I guess two months ago now. Yes, it's hot off the press.

[Dr. Amy Park]
Any other parting thoughts that you can give to the listeners on this topic or anything else that's like top of mind, since I have your ear?

[Dr. Matt Reeves]
No, I think we covered everything. If you haven't thought about Rh antigens and all this for a long time, it's worth thinking about again, about how it works and whether you need to use RhoGAM. Hopefully this will decrease the use of RhoGAM when it's not needed and make it easier for everyone to get it when they do.

[Dr. Amy Park]
Absolutely. Yes, I think access is a huge issue. Thank you so much for illuminating us and the listeners. Then you can follow Dr. Reeves clinic on Instagram, which is how I follow it. I follow the latest news related to late breaking stuff. Then are there any other resources on this topic that people can look at online or anything else? I think SFP has a statement on it, right?

[Dr. Matt Reeves]
Yes. SFP has a statement that just came out earlier this year. ACOG should be releasing something probably early next year. There are WHO guidelines that are available online as well, so there's lots of info. If you can get to JAMA, Sarah Horvath was the first author of that paper last month, but there are only so many papers on Rh exposure and abortion. Sarah Horvath, coauthor is Courtney Schreiber is the senior author, volume 330, issue 12. I'll read the little DOI thing, but it came out on September 26th.

[Dr. Amy Park]
Hot off the presses, guys. Thank you so much, Matt, for coming on the show and for telling us about this really important topic. I think it's going to be practice changing. It obviously already is. I find it super interesting to delve into these areas that you just take for granted as part of your medical training, and then you realize that it's not based in a lot of-- There's definitely a rationale to do it, but when you dig deeper in the first trimester of data in particular and you review of the science, it's a different story. I think that's going to be one of the trends that we see in medicine as well, just trying to–

[Dr. Matt Reeves]
I hope so. We get more and more data about things that we thought we had data about that we really didn't.

[Dr. Amy Park]
Yes, exactly. Exactly. Okay, cool. We'll see you, okay?

[Dr. Matt Reeves]
All right. Great talking to you.

[Dr. Amy Park]
All right. Thank you.

Podcast Contributors

Dr. Matt Reeves

Dr. Matt Reeves is an obstetrician-gynecologist and the executive director of DuPont Clinic in the Washington DC area.

Dr. Amy Park

Dr. Amy Park is the Section Head of Female Pelvic Medicine & Reconstructive Surgery at the Cleveland Clinic, and a co-host of the BackTable OBGYN Podcast.

Cite This Podcast

BackTable, LLC (Producer). (2024, January 23). Ep. 45 – RhoGAM’s Role in Pregnancy: Facts & Controversies [Audio podcast]. Retrieved from https://www.backtable.com

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.