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🔔 GUIDELINE ALERT ⚠️ Are you giving RhIG correctly for Early Pregnancy Loss?

  • The Review Course in Family Medicine
  • Jun 20
  • 2 min read

A man holding up a glass of whisky

Up to 15% of pregnancies result in early pregnancy loss (EPL), and the new SOGC guideline on Early Pregnancy Loss is here with major updates for 2025:

·       Update: Rh Immunoglobulin (RhIg) use has changed

·       Strong focus on mental health and patient-centred language & care

·       Clearer guidance on antibiotic prophylaxis


Don’t forget to see the exclusion criteria at the end.


KEY POINTS


1. As Easy as 1, 2, RhIg

Current evidence shows the amount of fetal blood in maternal circulation before 12 weeks doesn't reach a level to cause alloimmunization. The earliest recorded sensitization was at 16 weeks.


Bottom Line: Easy as 1, 2, RhIg: No RhIg for EPL before 12 weeks.


EXCEPTION: Consider RhIg on an individual basis for pregnancies between 10-12 weeks, after a shared decision-making discussion with the patient.


For more details, see the 2024 SOGC guideline on RhIG.


2. Mental Health is NOT an Afterthought

EPL has major psychosocial consequences, and patients have higher rates of anxiety, depression, obsessive-compulsive-disorder, and PTSD.


How can we help?


  • Empathy:

 Grief is common, made harder due to guilt and self-blame. However, “most often there is nothing the patient could have done to impact the outcome, and misinformation is harmful”


  • Communication:

 Use patient-preferred language like "miscarriage" or "Early Pregnancy Loss" and avoid terms like "spontaneous abortion."  See our TikTok video on this


  • Screening:

 Screen patients diagnosed with pregnancy loss for depression


  • Treatment:

 Offer time off work, treatment, or referral to mental health services for those with symptoms.

 

3. Know the new options

For EPL, discuss options with medically stable patients: expectant, medical, or surgical. New evidence-based options exist (mifepristone + misoprostol) that are superior to single-dose misoprostol. These have higher success rates than misoprostol alone, but are still too expensive (about $340 in Canada, 10x more than other countries…the authors advocate for it to be FREE).


See the guidelines for dosing as evidence is nuanced especially after 10 weeks.


4. Antibiotics: A Clear Rule

The guidance on prophylactic antibiotics is now very specific.

- YES to antibiotics for Procedural (Surgical) Management

- NO to antibiotics for Medical Management


Who Are These Guidelines For? (And Who They're NOT For)

These guidelines are for healthcare providers managing patients with early pregnancy loss (EPL) of a “normally sited intrauterine pregnancy.”


Importantly, these guidelines do not apply to:

·       Pregnancy of unknown location (PUL)

·       Ectopic pregnancy


Recurrent pregnancy loss (defined as 2 or more losses)


Note about recurrent EPL: Current definition is THREE or more consecutive unexplained first trimester EPL, but newer guidelines encourage full investigation after TWO if pathology is suspected


Sources:

 
 
 

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