Readers' Featured Comments/Questions - Why Wait to Conceive after Miscarriage and Rh-negative Concerns
Tuesday, September 04, 2007
Kenneth F. Trofatter, Jr., MD, PhD
I found out from my OB today that I miscarried (I found out I was pregnant on 8/22, and began bleeding on 8/29, he ordered a hCG level test which went from 12 to 2 in a 48 hour period, therefore, confirming a miscarriage). I have had only two other pregnancies, which resulted in two healthy children (now 4 years and 21 months). Anyway he said I had to wait for my next menstrual cyle to start trying to conceive again - why do we have to wait?
To Anonymous Sept 2: I am sorry for your loss. Since you have had other normal pregnancies, the overwhelming odds are that this baby you lost was chromosomally abnormal. You lost this pregnancy so early (very low hCGs) that it probably wouldn't make any difference if you "tried again" during the next cycle. But, I too usually suggest that a woman wait for one normal period before trying again, just to give any 'inflammation' that was associated with the recent loss a chance to resolve to improve the probability of successful implantation the next time around. Waiting also gives your hormones and the endometrium a chance to get back in 'synch' and this too might improve the chances for a successful pregnancy. Thanks for reading and for a good question that, I am sure, is on the mind of many women who are in a similar situation! Best of luck on the next go-around! Dr T
Anonymous has left a new comment on your post "Implications of a "Negative" Blood Type":
I was recently pregnant and miscarried at 6 weeks. Since I am Rh-negative, I was given a shot of Rhogam and was told that it would last in my system for three months. I am pregnant again (5 weeks) and know that the Rhogam is no longer in my system. Will I need another shot ASAP?
To Anonymous Sept 2: Your doctor will perform an antibody screen on you as part of the standard 'new OB' labs early in this new pregnancy. If there is no evidence of sensitization, i.e., you haven't developed any antibodies against Rh-antigen (odds are you were entirely protected from becoming sensitized by having gotten Rhogam with your miscarriage), then you will not get another shot of Rhogam until about 28 weeks, unless you have an indication such as bleeding, trauma, or an amniocentesis with this pregnancy before then. Best wishes this time around and thank you for reading! Dr T
Anonymous has left a new comment on your post "Implications of a "Negative" Blood Type":
Hello! I am A- and my husband is O+. Will we have problems conceiving or problems during the pregnancy because of our different blood types?
To Anonymous Sept 3: Your different blood types should not increase difficulty conceiving. Because you are Rh-negative and your husband is Rh-positive, you are at a small risk of becoming 'sensitized' to the Rh-antigen during a pregnancy (if the baby is Rh-positive like your husband) or at the time of delivery. However, getting Rhogam (which contains anti-Rh antibody) during and after the pregnancy greatly reduces the chance of isoimmunization because it helps your body get rid of any fetal blood cells that have gotten into your circulation before your own body makes antibodies to them. In fact, it may actually suppress your immune system from making Rh-specific antibodies! I certainly wouldn't sweat the issue at this point! Go out (or stay in) and get pregnant and don't fret about this. Thanks for reading! Dr T
Labels: blood types and pregnancy complications, early miscarriage, Rh-isoimmunization
10 Comments:
At Thu Sep 06, 02:11:00 PM 2007,
Anonymous said…
If the Mother is ab positive and the father is ? neg is there any problems with those matches or is the problem only if the mother is neg and the father positive? Thank you
At Sun Sep 09, 06:27:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Sept 6: With those blood types, there should be very little risk of Rh-isoimmunization. Our major concern is if the MOTHER is Rh-negative and the father is Rh-positive. Thanks for reading! Dr T
At Mon Sep 17, 02:07:00 PM 2007,
Anonymous said…
Dr-
i just had my third miscarriage and the first one, i didn't have tested, the second one was a partial mole pregnancy and after the waiting period was over, i got pregnant for the third time. I lost the baby in week 6 and test just came back where the fetus had 47 chromosomes. my dr thinks it's a fluke and that my husband and i just had bad luck. do you suggest trying again or do you think i have a chromosome condition?
At Thu Sep 20, 04:44:00 PM 2007,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Anonymous Sept 17: From what you describe, I would have to agree with your doctor at this point. You have probably just had a string of bad luck. The first pregnancy could have been lost either because it simply was a first pregnancy and your immune system didn't figure out how to help it hang on or that baby could have had a chromosomal abnormality. The last two pregnancies were clearly chromosomally abnormal, but they were also different abnormalities. If you are anxious enough, consider having chromosomal studies done on you and your husband. - but, I bet now they will be normal. There may be some individuals who are at increased risk for aneuploidy that we don't thoroughly understand. Some genetic counselors will tell you that having a documented aneuploid pregnancy increases your risk to as much as 1% that you will have another. You did not tell me your age, but if you are less than 38, this is higher than your age alone risk. I would recommend to anyone who has had chromosomally abnormal pregnancies that they seriously consider having combined first trimester screening for aneuploidy, regardless of their age. Thank you for reading and I certainly wish you better luck in the future. Dr T.
At Fri Jul 18, 11:10:00 AM 2008,
Anonymous said…
hi im 7 weeks and 3 days pregnant i recently had intercorse and after that i noticed when i wiped i had a little bit of spoting it went away for the whole day but came back that evening i have been spooting brownish pinkish blood i went to the doctor and they did a pelvic exam they said the cervix was closed so that looked good but they did a blood test and the doc said that my hormone level was lower then normal for being 7 weeks so i go back this weeked to test the hormone level to see if it goes up is it possible thire was a misscalculation in how far along i really could be
At Fri Jul 18, 06:42:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous July 18: At 7 weeks, they should be able to answer the question about how the baby is doing by a simple ultrasound. Good luck! Dr T
At Thu Sep 04, 05:23:00 PM 2008,
Anonymous said…
I had a partial molar preganancy last year and D & C after that. With the Doctors suggestion after 1 year 2 months i became pregnant again. Again i had a miscarriage at 6 weeks due to low progesterone levels. my doc said she will refer me to a infertility specialist. I feel so dispressed and unhappy about this..what will be the cure for this?..Iam 27 years old and no kids yet.
At Sun Sep 21, 05:56:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To anonymous Sept 4: I apologize for the delay in answering, but I JUST got your comment delivered to my mailbox today. The answer depends on what the REI doctor finds as a possible cause. One of the first thing will probbalt be to perform chromosomal studies on you and to evaluate your uterine cavity by sonohysterogram and/or hysteroscopy, in addition to a buch of 'hormone studies'. However, you are young and the overwhelming odds are that you will successfuly have a baby or two or three...If you want to have some idea of the workup for early pregnancy losses, check out my series of posts in March and April of 2007 in my archives. Best wishes. Dr T
At Sun Oct 19, 03:08:00 PM 2008,
Claudia said…
Dr. I learnt I was pregnant on 8th of october (home pregancy test and blood test came out positive). This is my first pregnancy and my husband and I were really looking forward to it. I'm 32 years old, weight 130 pounds, exercise 4-5 times a week (spinning mainly)and have a very healthy lifestyle (don't smoke, very few alcohol, good nutrition) as does my husband. My first day of my last period was August 30th, therefore I was on my 4th-5th week of pregnancy. My doctor asked me to perform 2 more blood tests: progesterone and Hcg. Progesterone was 27 and Hcg 243. He asked me to perform both tests 4 days after, progesterone fell to 21 and Hcg almost doubled to 493. He recommended Progest 200mg in order to increase the progesterone levels. 6 days after, he asked me for some other blood tests (hemoglobin, varicella, rubella, HIV etc. etc. etc) and included progesterone and Hcg once again. Every result was perfect but progesterone went down to 12 and Hcg instead of doubling dramatically dropped to 91.18. I thought it was a mistake from the lab and re-ran the test but both results kept on dropping. Next day went for an ultrasound and my uterus didn't show anything. The sonographist only noted certain amount of fluid/liquid in the pelvic area. I haven't had any symptom of miscarriage, I have only had minor cramps (similar to menstruation, but they're not constant, nor have I felt any discomfort in the pelvic area, my boobs are still sensitive though and a little bigger in size. My question is, what exactly happened? was there a pregnancy or not? why did the hormone levels dropped? and when will my body reject the embryo if one was formed? What does the fluid/liquid found mean (considering I don't feel any kind of pain, fever or so). Should I ask my doctor to perform a D&C?
I have an appointment with him tomorrow, but I just wanted to have a second opinion having found your site and advice so useful. Thank you very much!
At Wed Oct 22, 05:50:00 PM 2008,
Kenneth F. Trofatter, Jr., MD, PhD said…
To Claudia: Yes you were pregnant, but you had a VERY early loss - somtimes referred to as a 'blighted ovum'. Most of these are the result of having conceived a baby with a chromosomal abnormality. At this point you do not need a D&C. That may actually cause more harm than good. I am sorry for your loss. Kind regards, Dr T
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