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pre-pregnancy appointment 
13th-Dec-2012 08:39 pm [rh factor, ttc]
Hello all!
I have been following this community for awhile now and figured I'd post here to get some input. We have decided to begin ttc and we/I want to have a pre-pregnancy appointment to figure out if I should lose some weight before becoming pregnant, what we/I can do to have a healthy start, etc. I'm not sure what to except or what to ask. One thing I want more information about is the RH factor. I had a miscarriage about nine years ago when I was 21 and remember receiving a shot and the nurse mentioning something about future pregnancies.

Any thoughts or info you can provide would be helpful!

14th-Dec-2012 01:48 am (UTC)
I had a "pre conception" checkup with my midwife that basically consisted of me telling her we wanted to start a family... She took weight, blood pressure, we went over nutrition, tips for getting pregnant (I have a tilted uterus) and that's about it. All things considered it was a pretty easy appt.

Good luck!
14th-Dec-2012 02:32 am (UTC)
I believe I also have a tilted uterus. I'm not due for my yearly pap smear until march. Should I wait until then for this appt? I need to call my insurance company again to see if they will cover another pap before its due. Not sure if getting a pap prior to conceiving is even necessary.
14th-Dec-2012 02:41 am (UTC)
I'd get the pap done so you can avoid one when you're pregnant. :) This strategy worked for me, haha.
14th-Dec-2012 08:28 am (UTC)
To have the screening pap prior to conceiving would only be important in the hypothetical case that precancerous or cancerous cells are found that require therapy, so yeah, it could make sense to have the pap beforehand (not to cause cancer panic, but simply because chemotherapy etc., in pregnancy is not really possible, and *if* you have cervical ca., it can grow rapidly). If nothing is found, which is usually the case, afterwards you can of course say "uh, I didn't *need* to have it now after all!". So there isn't a 100% right or wrong time.

The tilted uterus doesn't mean much for most people. I have a retroverted one, too, and you may or may not take longer to conceive when you avoid certain positions... so the worst thing that could happen is that you don't get pregnant, it's definitely not a reason to delay TTCing until the appt.., because if you delay it, you won't be pregnant by the appt time for sure. At my pre-pregnancy appointment my uterus position wasn't even a topic, and while it took us six months to conceive, I think the irregular work absence of my husband was more of a factor in that as the tilt. ;-)

I would call the office and ask them if they can and would recommend to do the pap prior to you starting to TTC or not, and see what they say. If you're a low risk patient (no history of ovarial or cervical cancer in the extended family), they might even say to skip the yearly one this time.

Edited at 2012-12-14 08:34 am (UTC)
14th-Dec-2012 03:30 pm (UTC)
The pap recommendations have also changed, so depending on her age and risk factors, she might be okay to go every 3 years now between paps.
15th-Dec-2012 06:34 am (UTC)
I was going to say similar - it's 2yrly in Oz, and if you are pregnant they tend to not do a pap rather they do one at the six week post partum check. I never understood why there was urgency to pap every woman in pregnancy - opening the cervix must present a greater risk to a greater number of women, unless there's clear risk factors, than waiting until post pregnancy?
14th-Dec-2012 02:10 am (UTC)
if you are negative blood type and your partner is positive the baby will be positive and sometimes your body will reject it thinking its not supposed to be there. the shot makes it so your body doesn't auto reject the pregnancy.
14th-Dec-2012 06:16 am (UTC)
Not just so it doesn't auto reject the pregnancy, but it prevents potentially life-threatening blood disorders in both mother and baby.
14th-Dec-2012 03:33 pm (UTC)
What are the blood disorders that affect the mom? I am only aware of hemolytic anemia of the newborn as a risk factor.
15th-Dec-2012 07:37 am (UTC)
There aren't any, other than the risks of having a compromised fetus. It also isn't a given that the baby will be RH+ just because the father is.
16th-Dec-2012 11:42 pm (UTC)
Yeah, that's what I thought, I wasn't sure if this person knew something I didn't or was just confused.
14th-Dec-2012 03:32 pm (UTC)
It's not for this pregnancy, but for any subsequent pregnancies. If she were exposed to Rh factor in this pregnancy she would develop antibodies that would threaten the next pregnancy, not this one.
14th-Dec-2012 08:58 pm (UTC)
Yep, this. I'm Rh negative and husband is positive, and nothing was done about it during my first (and so far only) pregnancy but I got a shot of something after the baby was born, to prevent complications in future pregnancies.
14th-Dec-2012 02:34 am (UTC)
Good luck!!! :) exciting
14th-Dec-2012 05:22 am (UTC)
Thank you for sharing ( ^_^ )
14th-Dec-2012 11:16 pm (UTC)
The RH factor means that you are Rh negative and your partner at the time of your miscarriage was, more than likely, Rh positive. If your partner now is Rh positive, it means that any babies may also have Rh positive blood, which could accidentally mix with your blood during pregnancy or during the birth. This would cause your body to produce antibodies and could effect future pregnancies. The Rhogam shot prevents your body from making antibodies that would fight off Rh positive blood (i.e. a future pregnancy).

I am Rh negative and my husband is Rh positive. I received a Rhogam shot after my second miscarriage, during the pregnancy with my son (who was Rh negative so I did not need a shot after his birth) and during this current pregnancy. Once this baby is born, her blood will be tested to see if I require another Rhogam shot.

As for a pre-pregnancy screening, they aren't really necessary unless you have some specific concerns that may affect your ability to get pregnant - PCOS, irregular cycles, excessive pain/PMS. Apart from that, I imagine any doctor would just tell you to eat a healthy diet and get regular exercise and to start taking a prenatal vitamin. You may want to read "Taking Charge of Your Fertility" to learn about charting your cycles if you don't already. That can speed up the ttc part and/or provide useful information to a doctor should you not get pregnant within the year. I have a friend who was charting and ttc and when they weren't having any luck after 6 months, she took her charts to her doctor who found them helpful - they showed when/if she was ovulating and the length of her luteal phases, etc.
15th-Dec-2012 02:07 am (UTC)
I got a shot during my pregnancy because I was negative, but not after because my son was also negative when he was born. I got a shot with my miscarriage too, because I had bleeding.

The only thing that you really need to keep in mind with an rh- blood type is that if you have any bleeding at all, even spotting, you need to go to the doctor and get a rhogam shot.
15th-Dec-2012 03:45 am (UTC)
Thank you everyone for your thoughts! We are super excited to start ttc! Thanks for further explaining rh factor.
15th-Dec-2012 06:39 am (UTC)
I went and got a full blood work up pre pregnancy - some vaccines are not safe during pregnancy, but you really want your immunity up (rubella, whooping cough etc) and a check of iron levels etc is a good idea. (I'm a coeliac so I have problems with iron, calcium etc levels, but it is worth checking even if you aren't.)

They also did a full STD/STI workup - it needs redoing probably when you get pregnant, but it's good to know you are all in the clear (even though there was virtually no chance for me to have caught anything) so you can relax and not worry about any symptoms etc as well.

Chatted to the doc, got some info about early pregnancy symptoms and foods to avoid etc if I got pregnant etc.... easy peasy.
15th-Dec-2012 07:32 am (UTC)
If you're Rh- and your partner is Rh+, your baby may be Rh+ as well because it's the dominant trait. If the mother is exposed to Rh+ fetal blood (shouldn't happen, but can happen at birth, with a miscarriage or abortion, or with something like a placental abruption) her body will develop antibodies to the Rh+ blood factor and can attack a future Rh+ baby's blood. The Rhogam shot prevents sensitization if you've been exposed. It needs to be delivered within 72 hours or it may not be effective. If you had an early miscarriage, it's likely you weren't even exposed to fetal blood; it's more likely with late miscarriages. If you are sensitized, you would have to be monitored very closely in future pregnancies. It's dangerous for babies, but they can monitor the baby and even treat it with blood transfusions in the womb. They've come a long way in the treatment and prevention of this condition.

If you're still concerned about it, you can always have them test you to see if you're sensitized. I had a miscarriage followed by a pregnancy with an Rh- baby, followed by a miscarriage. I did not have a Rhogam shot with the second miscarriage, so for my peace of mind I had them test me when we started TTC and I am not sensitized. I know my husband is Rh+, so it was a valid concern for me. Luckily, since our daughter was Rh-, we know that he is +/- rather than +/+, so we know I only have a 50% chance of having an Rh+ baby.

If you have any significant bleeding during this pregnancy, be sure to contact your doctor immediately and to get the Rhogam shot. They'll give you a Rhogam shot in late pregnancy, just in case you get exposed, and then you'll need another shot after birth if your baby is Rh+.

Edited at 2012-12-15 07:40 am (UTC)
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