# Rhogam for early miscarriage?



## katja

I'm pretty sure I just miscarried at about 6 weeks, and I'm wondering if I need a Rhogam shot this early. (I am rh-, if you are wondering) If I do, how soon after m/c does it need to be administered? I don't have a care provider yet, so I'd just as soon skip it if I can. Thanks, if anyone here knows the answer.

Katja


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## mamaana

Katja, sorry about your loss







.

I would love to see a reply as I had an early m/c in Sept and it didn't even occur to me to get a rhogam shot and I can't help but wonder if that caused my latest loss in March.

Ana


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## tomjon

hi,
so very sorry about your loss. I am rh- and had a m/c at 6 weeks. I was told to DEFINITELY get a rhogam shot by my ob of 9 years. She delivered our two boys and i trust her to know. I do know that you have 72 hours from birth or m/c so you have may have some time. If worse comes to worse I would go to the eroom to try to get it. It could really save you from some major problems with future pregs.
good luck
big hugs,
tomjon


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## taradt

i was told it always needs to be done when there is no way of telling what blood type the baby was. but then i wonder what happens to mothers that miscarry before they know they were pregnant?

let us know when you find out

tara


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## Arwyn

First off, do you know the "sperm donor's" blood type? If it's neg also, no worries! (Lucky!)

Secondly, as my midwife explained it, the embryo/fetus needs to have its own blood supply going in order for there to even be a potential of sensitization due to comingling of blood.

Thirdly, there has to be comingling, which, while it's possible with any miscarriage, isn't all that likely, and especially not with a "so early I didn't know I was pregnant!" one.

I'm not sure at what fetal age that becomes possible, but I've been assured that a really early miscarriage carries virtually no risk.


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## sweetmomma

i'm sorry for your loss, i know how hard it can be

yes you need to get the shot and like someone else said you have up to 72 hrs to do so, please try to get it because that shot can prevent problems with your future pregnancies including preventing another miscarriage

mamaana i'm sorry for your loses as well, are u rh - ? if you are then not getting the shot could have been the cause of your second miscarriage....... did you get the shot the second time around? how come your doctor didn't say anything?

i've had two miscarriages and gotten the shot every time and after each one had gotten pg afterwards with no problems


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## katja

Well, I just got back from my 5-hour wait in the e room. Woohoo! I guess they give a mini dose for such an early miscarriage.


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## mamaana

Quote:


Originally Posted by *sweetmomma*
mamaana i'm sorry for your loses as well, are u rh - ? if you are then not getting the shot could have been the cause of your second miscarriage....... did you get the shot the second time around? how come your doctor didn't say anything?

Well, now I'm really worried because I am A-, dh is A+ and ds is A+. I have an appointment with my RE in May and I'll ask then but my regular dr. doesn't do obstetrics and probably doesn't really know. I go to a pregnancy clinic for that.

Can anything be done now? I have a very deep feeling that I'm pg but I'm only 9dpo and it's too early to test. Have I screwed up my chances to ever carry a pregnancy to term?

Ana


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## Arwyn

Quote:


Originally Posted by *mamaana*
Can anything be done now? I have a very deep feeling that I'm pg but I'm only 9dpo and it's too early to test. Have I screwed up my chances to ever carry a pregnancy to term?

Ana

Nope and nope! If you're sensitized, you're sensitized - fortunately, for all the fuss that sensitization gets, it isn't actually guaranteed to happen. It's much more likely if you had a high-intervention or surgical birth, with your flesh being cut open (episiotomy or cesaerean) and allowed to mingle with your A+ baby's blood, or with a highly managed 3rd stage (especially cord traction). Even then, though, it isn't guaranteed to happen.

Furthermore, sensitization gets worse with repeated exposures. Bad if you want to have lots of kids and don't want to use Rhogam*, but good if you're only planning on one or two more. Also, it should be mentioned that your DH _could_ be carrying a hidden rh- chromosome, making it possible (a 50/50 chance, even) that your next child won't even be positive - in which case, no problem!

* Note, Rhogam can potentially prevent sensitization, but I'm not sure if it can prevent sensitization getting worse. I can consult my Frye's text and get back to you about that.

Finally, even with sensitization, it is entirely possible to carry to term and end up with a healthy child - _after_, unfortunately, lots of medical intervention, sometimes to the extent of early delivery and complete blood transfusion for your newborn. A very dear friend of mine was a rh+ baby born to a highly sensitized rh- mom, almost fifty years ago, and she's doing just fine - but she was delivered early and had a complete transfusion.

Hope that helps.


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## mamaana

Thank you Arwyn for your reply. That makes me feel a lot better. We do actually want another 3 kids and I have no problem getting a Rhogam shot.

Ana


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## Arwyn

I love Anne Frye.

Ok, here's what she says about RhD sensitization:

sensitization is possible "as a byproduct of abortion or miscarriage occuring past 30 days gestation/44 days post LMP... the risk of Rh sensitization after an abortion of any type at 6-8 weeks is very low, although it rises by 10-12 weeks of pregnancy."
"The overall risk of developing antibodies for the Rh-negative mother of a first Rh(D)+ baby is about 16%." (although she says later "Apporximately 13% of all Rh-negative mothers will become sensitized with their first Rh-positive baby if they do not receive a postpartum injection of Rh0(D) immunoglubulin... to prevent antibody formation."
"After a miscarriage the risk is about 2% and after an induced abortion it rises to 4-5% at 20 weeks genstation."
"Once formed, anti-Rh(D) IgG antibodies will remain in the system of the Rh[negative] mother. During a future pregnancy, they can cross the placenta and enter an Rh-positive baby's system. Additional blood mixing is not necessary for this to occur."
"Once sesnitization occurs, all future Rh-psoitive babies are at risk for blood cell destruction."
"one-third of all Rh-negative women are never sensitized by infusions of Rh-positive blood" although some produce severe reactions.
Frye, Anne Understanding Diagnostic Tests in the Childbearing Year, 6th edition

sorry for the typos - have to run. let me know if you have any more specific questions.


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## Nicki_Cooper

I'm so sorry to hear of your loss.

Please ensure you go and get the Rhogam vaccine. I have just m/c at 6 weeks and was told by three different dr's the importance of the shot to avoid my being sensitized as a result of my being RH negative. To back this up my midwife also said this was a must to avoid problems with the next pregnancy. This vaccine is also needed during a healthy pregnancy at 28 weeks gestation and again following birth. Also is needed if an amniocentisis test is done.

If you haven't already done so please go and get this vaccine... for your health and the health of your future pregnancies. You might have a little bit of discomfort at the injections site (hip) and my run a mild fever for about a day following but in my books the ability to avoid any problems going forward this is well worth it.


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## Arwyn

First off, it has nothing to do with the mother's health; only potentially that of future pregnancies (well, the babies of the future pregnancies). Secondly, as stated above, there is no guarantee that an exposure with a miscarriage will 1) happen and 2) result in sensitization. There is also, as with any "vaccine," no guarantee that it will work (for one thing, the exposure could have occured before the woman was aware she miscarried, making her receive the shot after the three day window has passed).

Which is not to say Rhogam should not be sought out after a miscarriage, just that it is a subject about which a woman (as always!) has a right to informed choice. It's not a black-and-white, she-must-do-this-or-else kind of thing.

Also, it is not "needed" at 28 weeks and after birth, those are just the standard times of injection, based on a "what-if" protocol. It is entirely possible for a woman to go through her pregnancy and birth without experiencing any exposure to her fetus' blood (although it is also entirely possible for said exposure to happen anytime during that period). And 28 weeks is fairly arbitrary; if exposure occured more than three days before the shot, the woman will already have started the sensitization process; or if it happens enough after, the protection from the shot will have worn off.

Please, don't think that having a shot after every miscarriage and at 28 weeks and birth (and amniocentesis, and external versions, and any major falls or car accidents) will offer you 100% protection - or that missing those shots will guarantee sensitization. The truth is much more complicated than that, and to protect yourself (or rather, your future children) adequately, you should know all about those complexities.

Again, I'm not against Rhogam, especially now that thimerosol is no longer the preservative-of-choice (there's a decent chance I will choose to use it sometime during any of my future pregnancies), I just (strongly!) believe that education and informed choice are much more important than following any particular protocol.


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## Diane~Alena

Quote:


Originally Posted by *Arwyn*
First off, do you know the "sperm donor's" blood type? If it's neg also, no worries! (Lucky!)

Secondly, as my midwife explained it, the embryo/fetus needs to have its own blood supply going in order for there to even be a potential of sensitization due to comingling of blood.

Thirdly, there has to be comingling, which, while it's possible with any miscarriage, isn't all that likely, and especially not with a "so early I didn't know I was pregnant!" one.

I'm not sure at what fetal age that becomes possible, but I've been assured that a really early miscarriage carries virtually no risk.

Ditto to that ! I was told the exact same thing in fact I believe it also says similar in the what to expect when you are expecting book too.

I hope you are doing well after the loss and I am so sorry you are having to think of this at all.


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## 68825

this is a very old thread. i came across it on a google search.

anyway, as i just had a chemical pregnancy - af was not late, but i tested early, got several bfps, had all the symptoms, etc...then tested -, and said hello to af, i didn't even think about needing rhogam.

in 11/06 i miscarried at 6 1/2 weeks and got the shot right after i began to spot.

anyone have any insight into this? is the shot i received in november still good? i can't seem to find any straightforward info. online. most sites say to get the shot no matter how early, but there is nothing to back it up.

thanks in advance!

rain


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## Mindi22

I accidently duplicated post. I deleted this one.


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## Mindi22

Quote:


Originally Posted by *Arwyn* 
Again, I'm not against Rhogam, especially now that thimerosol is no longer the preservative-of-choice (there's a decent chance I will choose to use it sometime during any of my future pregnancies), I just (strongly!) believe that education and informed choice are much more important than following any particular protocol.

I do believe that Rhogam actually still has thimerisol in it. (http://www.icpa4kids.org/research/ar...newsletter.htm) There is an alternative vaccine that does not, it is listed in the above article - "Bayer Pharmaceuticals under their product name of BayRoh-D. This mercury free product has been available sine 1996. Their number is 800-468-0894."

HTH
Mindi


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## varaonaid

I've had a few miscarriages now and didn't have the chance to see a doc until a bit after. Since I've had more than one, I've been worrying that perhaps I was sensitized and that could have caused the subsequent miscarriages.

My OB said that if the miscarriages were before 8 weeks than sensitization would not have caused any subsequent one.

That made me feel very relieved until I read this thread. I didn't realize sensitization could occur so early, even if it's rare and I don't know how early (if sensitization occurred) that it could be a factor in subsequent pregnancies.

Thoughts?


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## 68825

vera - it seems, from all i've read in the past few days, to be a precautionary measure to give rhogam after early miscarriages. you could ask for a blood test to find out if you have been sensitized if you are really worried about it.

how early were your miscarriages?

rain


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## varaonaid

Quote:


Originally Posted by *raingyrl* 
vera - it seems, from all i've read in the past few days, to be a precautionary measure to give rhogam after early miscarriages. you could ask for a blood test to find out if you have been sensitized if you are really worried about it.

how early were your miscarriages?

rain

Hi Rain,

They were at less than 6 weeks for the first three but this last one, well, it's unknown because it was a "missed abortion". Unfortunately the docs couldn't tell me. Also by the time we found out about the pregnancy loss, it was already late in the third trimester and way past the time that Bay-Rho or Rhogam would have been helpful (a really long story that I post in "my loss story" - I won't bore anyone with it a second time here).

They did some blood work on me but didn't include any sensitization. The doc didn't seem to be worried about it. Perhaps if I get preg again, they'll do a full workup then.

Thanks for responding to my question, Rain. I really appreciate it.

Rachel


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## maxmama

Quote:


Originally Posted by *raingyrl* 
this is a very old thread. i came across it on a google search.

anyway, as i just had a chemical pregnancy - af was not late, but i tested early, got several bfps, had all the symptoms, etc...then tested -, and said hello to af, i didn't even think about needing rhogam.

in 11/06 i miscarried at 6 1/2 weeks and got the shot right after i began to spot.

anyone have any insight into this? is the shot i received in november still good? i can't seem to find any straightforward info. online. most sites say to get the shot no matter how early, but there is nothing to back it up.

thanks in advance!

rain

Rhogam remains active for 12 weeks. Each dose is effective against a certain volume of fetal blood, which is why MicrhoGam is given up to 12 weeks gestation and a full dose is given thereafter.

It is extremely unlikely that an early miscarriage had a large enough blood volume to sensitize, but I would always get RhoGam. I'm sensitized to Kell (essentially the same issue as Rh, but without any prophylaxis available) and I don't really need another antibody issue.


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## 68825

maxmama, thanks for the info.

rachel, i hope you do get pregnant again if that is what you want! i know how hard it can be to feel confident about the process again once you've experienced a loss, or many losses.

i find reassurance in the fact that only a small percentage of mothers are sensitized at birth - without the rhogam. i don't know if a sensitization test is included in the full work up unless we ask for it. do you sometimes get the feeling that docs don't really know to much about this? it seems to be up to us to figure out!

take care,

rain


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## maxmama

Sensitization shows up on the standard antibody screen done prenatally, and could be done in between, but no one really does.

I agree about the docs not paying attention to this. I'm a gravida 5 (five pregnancies), and except for my two term births, no one offered me RhoGam until I asked. The response was usually, "Oh, yeah, we need to give you RhoGam." Good thing I knew to ask, right?


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