QuestionHi Dr. Trevett--
I am 24, married, and not necessarily trying to have children at this point in time. I have a few questions--I might be pregnant as we speak, but I won't know for at least a week or so--can you help me?
First, I have 'A negative' blood. It occurred to me that I might need to be concerned about whether I have had a chemical pregnancy before...if I have and didn't know it (and hence never received the RH injection), am I likely to have trouble getting pregnant? I wouldn't be surprised if I have had a very early miscarriage before--my husband and I have been using only the withdrawal method of birth control for the last 8 months, and I've been sexually active for 10 years, with and without protection. A previous chemical pregnancy is entirely possible.
What are the risks that I could have developed the RH sensitivity during a chemical pregnancy?
Also, my father and his siblings have Factor V Leidens, though I myself have never been tested (I don't want that on my medical record until it has to be, just in case. Preexisting conditions and whatnot, you understand). How much of a risk does Leidens pose with regard to miscarriage, and does it have anything to do with the RH sensitivity?
I am very concerned that I will be unable to sustain pregnancy because of a past--unknown--miscarriage. Is there anything I can do at this point, if I have developed the sensitivity?
Thank you for your time--I look forward to your reply.
rhiannon
AnswerRhiannon,
To answer your questions:
1. If you have Rh negative blood and have been exposed to Rh positive blood (by a chemical pregnancy) you still would not have a problem getting pregnant. You might have had a reaction to the Rh negative blood, although that is unlikely, probably less than a 1% risk. We routinely screen for this reaction with your first blood draw at your first OB appointment (the blood type and screen test, the latter of which would detect any reaction your blood may have had to Rh positive blood).
2. The factor V leiden mutation has nothing to do with Rh negativity. We do know that some women who have this or other problems that make wome more likely to have a blood clot do have some problems with repetitive miscarriages. It would be a good idea to tell your OB so that he or she can test you for that now.
3. At this point, there is not a lot that you need to do other than let your OB know that you may have a factor V leiden mutation. Some women who have repetitive miscarriages and factor V leiden mutations are placed on blood thinning medication during early pregnancy, with some success. This is not something that you should do until your doctor confirms a problem like this though as there are risks involved in the treatment such as heavy bleeding.
4. If you have a sensitivity to the Rh positive blood, we'll find out on your blood test and that starts a whole chain of other tests which your doctor will explain to you.
