Talk to me about Rh factor and pregnancy

August 4, 2015 10:26 AM

After a miscarriage at 12 weeks, it seems that I might be Rh negative or 'lightly positive'. This comes as a surprise since I was told during my first pregnancy that I was Rh positive. My gynecologist and GP keep telling me it's not a big deal, but should I be worried? What else should I know about borderline Rh factor?

I have had one successful pregnancy in the UK, where I had some mild bleeding in the first trimester and then a straightforward delivery. For all of this, I was told I was Rh positive, so received no immune globulin injection.

Now, 3 years later, I had another pregnancy, which unfortunately ended in a missed miscarriage at 12 and a bit weeks, this time in the Czech Republic. The hospital did a test of my blood, which was inconclusive, and gave me an immune globulin injection to be on the safe side since the baby tested positive. Since then, I keep submitting blood to be tested and haven't gotten any answers (not enough blood, wrong lab, results lost, not enough blood, and just today, some technical problem that meant they couldn't do tests on it). This has been going on for four months and I'm completely fed up.

I'm having trouble getting answers from my doctors' - there is a language barrier at times and both reassure me that it's not a problem, I can take shots (which , Mayo clinic among other web sources seems to dispute if I've already been sensitized in my first pregnancy). They also are taking the approach that we can deal with it when we know more, but well, it's been four months.

So, in full recognition that you are not my doctor/apparently inept lab technician, please oh please help. What are the chances that I have already been sensitized due to my first pregnancy? Could this have caused my miscarriage? How much of a risk would this be for future pregnancies? What exactly does this 'lightly positive' business mean (the hospital said they saw a few proteins, but not enough to say for sure that I was positive)? Do I need to find myself a hematologist?

I have been trying to research things online, but most of it seems aimed at 'why get your blood tested during pregnancy', so any links beyond the basic info or any personal or professional knowledge would be very much appreciated.

posted by brambory to Health & Fitness (11 answers total)

What is your child's blood type?
posted by treehorn+bunny at 10:52 AM on August 4, 2015

Response by poster: That's a good question. I don't know, but his father is O+.
posted by brambory at 11:33 AM on August 4, 2015

If you have Rh incompatibility, your first kid is always fine, and all subsequent kids are in danger if you don't get medical interventions. Here is an article about it, and what that "sensitization" means:

http://www.pregnancy.org/article/rh-incompatibility-and-why-you-need-rhogam

The language barrier is probably the issue here; you don't necessarily need a hematologist if you have a good OBGYN. The world was a different place before the advent of Rhogam; my mother is the older healthy child and her younger sister is profoundly mentally retarded and has been institutionalized her whole life, born just a few years too early for medical advances that would have resulted in a healthy baby. It's possible that in the Czech Republic they just don't have as much experience with this issue, and they are most certainly not used to self-advocating patients which is what you are.

If you're a UK citizen, you might try contacting your local consulate. They could possibly connect you with other health options that get you what you need, or connect you with a translator or health advocate than can assist you.
posted by juniperesque at 11:57 AM on August 4, 2015 [2 favorites]

I'm Rh negative and my husband's blood type is Rh positive. I needed to get RhoGAM shots at various times throughout my pregnancies, like when I had the amnio, any bleeding, stuff like that. My first pregnancy also ended in a miscarriage; I'm so sorry for your loss.
posted by lgandme0717 at 12:01 PM on August 4, 2015 [1 favorite]

I'm O- and my husband is O+. I had a full Rhogam regimen during pregnancy and delivery, which involved, if memory serves, a shot at 28 weeks and then another at delivery. We got pregnant easily with our son.

I'm sorry for your loss. We had a miscarriage after our second attempt to get pregnant, but it was very, very early, so likely to do more with a blighted ovum or other egg issues rather than Rh incompatibility.

Best of luck. You're going to be okay.

(Edited to add: I'm sorry. I just realized I haven't answered your question about sensitization. I'm not a doctor and I'm sorry if this adds so much noise to your thread. I just hope everything works out for you and that you get the answers you need. Please delete as you see fit.)
posted by TryTheTilapia at 12:24 PM on August 4, 2015 [1 favorite]

The way it was explained to me is that you can be rh negative but have a small component that reads positive. I don't understand this either. I just know I was always treated as O- during and after pregnancy including the shots, but the Red Cross considers me O+.
posted by tamitang at 1:20 PM on August 4, 2015

If your child is rho negative, you weren't sensitized.

This guideline on the use of Rhogam for a hematology society has a lot of information - albeit with jargon. I can come back and translate later. One item noted in several places is that if Rh testing is inconclusive, treat the woman as if she is negative.
posted by treehorn+bunny at 3:48 PM on August 4, 2015 [1 favorite]

I personally would find a hematologist, or a doctor who would treat me as if I were negative without conclusive evidence otherwise, especially following a miscarriage. While I can't answer your specific questions because I'm not a doctor or lab tech, I am O- and got Rhogam shots during and after both of my pregnancies. During my first pregnancy, I had unexplained bleeding before I knew my blood type, and was given a shot just to be on the safe side. My understanding is that the shot provides far more protection than risk to both mother and fetus, so if there is any chance that the mother is negative, general procedure is to get the shot.
posted by peanut_mcgillicuty at 7:51 PM on August 4, 2015 [1 favorite]

Best answer: I am not your inept lab tech and I mainly do chemistry not blood bank, but from what I can remember:
You could have weak D or partial D. If you look at the chart on page 2 here, if you have weak D you don't need rhogam but if you have partial D you do.
You don't need a hematologist, you need a lab that doesn't suck.
posted by get off of my cloud at 7:52 PM on August 4, 2015

Best answer: I finally found a page written for laypeople about what happens if you're Rh sensitized during a subsequent pregnancy. I hope you find it helpful, although it is not clear yet what your situation is. Here's another one that's pretty decent too.

To address another one of your questions - the Rh issue is probably not related to your miscarriage. Miscarriage is extremely common, and an exposure between fetal and maternal blood in early pregnancy that would cause Rh disease is rare. You can see more details on this and list of sensitizing events in the hematology society link I shared earlier.

Hope you get more helpful answers from your doctors soon. You really can deal with it when you know more, though - although it's frustrating to have had so many lab problems in a row, this isn't an issue that will affect your health unless you are pregnant.
posted by treehorn+bunny at 8:43 PM on August 4, 2015 [2 favorites]

Best answer: First, I'm so sorry to hear about your miscarriage and that you're struggling with finding answers. It sounds like the Czech hospital is probably giving you the correct information, though.

This isn't medical advice, but I am a midwife: it sounds like you have weak or partial D, which generally means that you are treated as Rh positive. The information you want to know is your "antibody screen"--this would tell if you have any antibodies (e.g., if you have been sensitized). Other good info to know would be your child's blood type and your partner's.

To respond to your specific questions:
- What are the chances that I have already been sensitized due to my first pregnancy?
If you _are_ weak D, then it's unlikely you were sensitized, but not impossible.
- Could this have caused my miscarriage?
Sensitization can cause a miscarriage, but it depends on to what you've been sensitized (e.g., what antibodies you have). If this were your first pregnancy after an Rh sensitization, I would doubt that the miscarriage were caused by the sensitization. Generally, the effects of Rh sensitization in the fetus progress over time and over subsequent pregnancies.
- How much of a risk would this be for future pregnancies?
If you are sensitized, yes, there is a risk to future pregnancies. In particular, hemolytic disease of the newborn is a concern. This can lead to a severe anemia and sometimes fatal complications for the baby.
- What exactly does this 'lightly positive' business mean?
Most moms with weak D appear Rh negative on screening but are actually Rh positive. The presence of an gene variant causes the D antigen to be weakly expressed. A true genetic weak D is an incomplete form of D antigen, and sensitization in this case is extremely rare. However, because it's so rare, but the consequences are high and easily preventable, this may be an indication for immunization.

Hope this is helpful. Feel free to memail me any more questions.
posted by stillmoving at 9:12 PM on August 4, 2015 [1 favorite]