Understanding Rhogam and Miscarriage: A Medical Discussion

Question
Hello Doctor, I am 37, have had several miscarriages, two ectopic pregnancies, have one tube left and have 1 18 year old son. I started spotting the day my period was due, then bled heavy with clots for 2 days, then spotted for another two weeks.  In that time I had a positive Home pregnancy test. Then I had bloodwork done, received a call saying that I was having a miscarriage and that I needed to come in that day for a Rhogam, which I did.  Two days later had more bloodwork done and got a call from the nurse who says maybe I am not miscarrying after all.  I was put on Prometrium and I am no longer spotting but still have bloating and mild cramps.  I have two questions, could this possibly be a viable pregnancy after heavy bleeding with clots? and IF this is a viable pregnancy, will having the Rhogam shot at about 5 weeks pregnant affect the development of the baby? Thank You for your time.

Answer
From the information you have given me I can assume that you may have been pregnant considering the positive pregnancy test(although it may be false) and you miscarried or aborted. Bleeding ,that to such early in pregnancy always leads to an abortion. To know if you are still pregnant or have had an abortion you will need an ultrasound exam.

Now coming to Rhogam. Rhogam is an injection given to women who are Rh negative and whose partners are of the RH positive blood group immediately after deliver or an abortion. Women who are Rh negative do not have the Rh antigen in their body. The rh antigen is a protein present on the surface of the blood cells and plays an important role in development of the blood cells. Now there is a 50% chance that the baby would be of the Rh positive blood group. So when the baby's blood cells are introduced into the blood of the mother during delivery or during an abortion, the mother's immune system is stimulated to produce antibodies which recognize the Rh antigen on the blood cells of the baby and kill it. This will not cause a problem to the first baby, but in subsequent pregnancies, the antibodies against the Rh antigen can cross in to the baby and destroy the blood cells of the baby. This may lead to fetal and neonatal jaundice, anemia  and severe cases death of the fetus. It is to prevent such a complication that a Rhogam is given to women who are Rh negative. The Rhogam is a genetically re engineered protein that binds to the Rh antigen and prevents the mother's immune system from being sensitized to the Rh antigen. It is to be given immediately, within 4 hours of deliver or abortion. To know more about abortion and bleeding in pregnancy visit http://www.pregnancyandchildcare.info/pregnancy_articles/bleeding.html