14.03.12 Anti-D prophylaxis

Screening

• Kleihauer screening test should beperformed within 2 hours of delivery

• Identifies RhD-negative women with a large FMH who require additional anti-D Ig

Timing

• Anti-D Ig should be given as soon as possible after the potentially sensitising event but always within 72 hours

Miscarriage

• Anti-D Ig should be given to all non-sensitised RhD-negative women who have a spontaneous complete or incomplete miscarriage at or after 12+0 weeks of gestation

• Anti-D Ig is not required for spontaneous miscarriage before 12+0 weeks of gestation, provided there is no instrumentation of the uterus

• Anti-D Ig should be given to non-sensitised RhD-negative women undergoing surgical evacuation of the uterus, regardless of gestation

• Anti-D Ig should be considered for non-sensitised RhD-negative women undergoing medical evacuation of the uterus, regardless of gestation

Threatened miscarriage

• Anti-D Ig should be given to all non-sensitised RhD-negative women with a threatened miscarriage after 12+0 weeks of gestation

• In women in whom bleeding continues intermittently after 12+0 weeks of gestation, anti-D Ig should be given at 6-weekly intervals

• Consider in non-sensitised RhD-negative women if there is heavy or repeated bleeding or associated abdominal pain as gestation approaches 12+0 weeks

Ectopic pregnancy

• Anti-D Ig should be given to all non-sensitised RhD-negative women who have an ectopic pregnancy, regardless of management

Therapeutic termination of pregnancy

• Anti-D Ig should be given to all non-sensitised RhD-negative women having a therapeutic termination of pregnancy, whether by surgical or medical methods

Prophylaxis following sensitising events before delivery

• A minimum dose of 250 iu is recommended for prophylaxis following sensitising events up to 19+6 weeks of gestation

• For all events at or after 20+0 weeks of gestation, a minimum dose of 500 iu anti-D Ig should be given and a test to identify FMH greater than 4 ml red cells performed

• Additional anti-D Ig should be given as required

  • In the event of recurrent vaginal bleeding after 20+0 weeks of gestation, anti-D Ig should be given at a minimum of 6-weekly intervals

Routine antenatal prophylaxis (RAADP)

• RAADP should be offered to all non-sensitised RhD-negative women

• RAADP is not required in women who are RhD sensitised

• RAADP is a completely separate entity from the anti-D Ig required for potentially sensitising events

Postnatal prophylaxis

• At least 500 IU of anti-D Ig must be given to every non-sensitised RhD-negative woman within 72 hours following the delivery of an RhD-positive infant

  • A test to detect FMH greater than 4ml must also be undertaken so that additional anti-D Ig can be given as appropriate

  • If the pregnancy is non-viable and no sample can be obtained from the baby, anti-D Ig should be administered to a non-sensitised RhD-negative woman