Preventing Rhesus D haemolytic disease of the newborn by giving anti‐D immunoglobulin: are the guidelines being adequately followed?
- 1 January 1997
- journal article
- Published by Wiley in BJOG: An International Journal of Obstetrics and Gynaecology
- Vol. 104 (1), 37-41
- https://doi.org/10.1111/j.1471-0528.1997.tb10646.x
Abstract
Objective To ascertain whether anti‐D immunoglobulin is being administered to Rhesus D negative women in accordance with the 1991 recommendations for its use to cover all events which may result in fetomaternal haemorrhage. Design The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations. Setting Seven maternity units using a central antenatal screening service. Participants Nine hundred and twenty‐two Rhesus D negative women delivered in these seven hospitals. Main outcome measures The prescription, dosage and indications for administration of anti‐D immunoglobulin to women during pregnancy and in the puerperium. Results Postnatal anti‐D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti‐D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 IU was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a ‘negative’ result interpreted as a reason not to give anti‐D immunoglobulin. Conclusion Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000–1500 IU), both of which would increase the requirements for this limited resource.Keywords
This publication has 7 references indexed in Scilit:
- Guidelines for blood grouping and red cell antibody testing during pregnancyTransfusion Medicine, 1996
- Value of Kleihauer testing after administration of anti-D immunoglobulinBMJ, 1994
- Causes and clinical consequences of Rhesus (D) haemolytic disease of the newborn: a study of a Scottish population, 1985–1990BJOG: An International Journal of Obstetrics and Gynaecology, 1994
- Towards the conquest of Rh haemolytic disease: Britain's contribution and the role of serendipity*Transfusion Medicine, 1992
- Efficacy and long term effects of antenatal prophylaxis with anti-D immunoglobulin.BMJ, 1989
- Controlled Trial of Various Anti-D Dosages in Suppression of Rh Sensitization following Pregnancy: Report to the Medical Research Council by the Working Party on the Use of Anti-D Immunoglobin for the Prevention of Isoimmunization of RH-Negative Women During PregnancyBMJ, 1974