The prophylactic use of Rh immune globulin has been a medical success, protecting women who could be at risk from exposure to the Rh(D) antigen. Thus, it is not surprising that Rh(D) immunoprophylaxis has been extended from women with term pregnancies to all women with miscarriages, abortions, and ectopic pregnancies. In this article we review the existing medical literature to assess the risks of fetomaternal hemorrhage and Rh isoimmunization after complications of a first-trimester pregnancy, induced abortion, or ectopic pregnancy. The evidence to support the use of Rh immune globulin in the first trimester is sparse, but there is theoretic evidence of its necessity. Despite weak evidence to support its use, there is little risk.