From the Guidelines
RhoGAM (Rho(D) immune globulin) should be administered after a spontaneous abortion before 12 weeks of gestation, with a recommended dose of 50 mg within 72 hours of the abortion, as indicated by the most recent guidelines from the Society for Maternal-Fetal Medicine 1. The administration of RhoGAM is crucial in preventing RhD alloimmunization, which can lead to devastating fetal and neonatal outcomes in future pregnancies.
- The risk of fetal-maternal hemorrhage increases after 8 weeks of gestation, making RhoGAM administration essential for Rh-negative women with Rh-positive partners or partners of unknown Rh status.
- The recommended dose of 50 mg is considered adequate to cover the volume of potential feto-maternal hemorrhage in the first trimester, and it may help decrease concerns about resource over-utilization with RhoGAM administration 1.
- If the 50 mg dose is unavailable, a 300 mg dose of RhoGAM may be substituted, as recommended by the Society for Maternal-Fetal Medicine 1.
- It is essential to prioritize RhoGAM administration for postpartum patients and antenatal patients at later gestational ages when the supply of RhoGAM is limited 1.
- The Society for Maternal-Fetal Medicine recognizes the importance of preventing RhD alloimmunization and recommends offering RhoGAM administration for spontaneous and induced abortion at less than 12 weeks of gestation in unsensitized, RhD-negative individuals, when logistically and financially feasible 1.
From the FDA Drug Label
HyperRHO S/D Full Dose should be administered within 72 hours to all nonimmunized Rho(D) negative women who have undergone spontaneous or induced abortion, following ruptured tubal pregnancy, amniocentesis or abdominal trauma unless the blood group of the fetus or the father is known to be Rho(D) negative.
Administration of RhoGAM after spontaneous abortion is recommended within 72 hours for nonimmunized Rho(D) negative women, regardless of gestational age, including those before 12 weeks of gestation, unless the blood group of the fetus or the father is known to be Rho(D) negative 2.
From the Research
Administration of RhoGAM after Spontaneous Abortion
- The administration of RhoGAM (Rho(D) immune globulin) after a spontaneous abortion is a topic of discussion in the medical field, with guidelines and studies providing insight into its use.
- According to the study 3, after miscarriage or threatened abortion or induced abortion during the first 12 weeks of gestation, nonsensitized D-negative women should be given a minimum anti-D of 120 microg.
- Another study 4 found that there are insufficient data available to evaluate the practice of anti-D administration in an unsensitised Rh-negative mother after spontaneous miscarriage.
- A review of RhIG products 5 highlights their effectiveness in preventing Rh-antigen alloimmunization in pregnant women, but does not specifically address the administration of RhoGAM after spontaneous abortion.
- An early study 6 demonstrated the effectiveness of RhoGAM in preventing Rh sensitization in Rh-negative women, but its focus was on postpartum administration.
- A study 7 examining the use of Rh immune globulin in Rh-negative women with first trimester spontaneous abortions found that the evidence to support its use is minimal, and the practice is based on expert opinion and extrapolation from experience with fetomaternal hemorrhage in late pregnancy.
Key Points
- RhoGAM administration after spontaneous abortion before 12 weeks of gestation is recommended at a dose of 120 microg 3.
- There is limited evidence to support the use of Rh immune globulin in Rh-negative women with first trimester spontaneous abortions 4, 7.
- The effectiveness of RhoGAM in preventing Rh-antigen alloimmunization is well-established 5, 6, but its specific use after spontaneous abortion requires further study.