Anti-D – Rh(D) Negative Women
Recommendation 1
- All Rh(D) negative women (without preformed Anti-D) should be offered Anti-D in the first trimester (250 IU) in cases of:
- Abortion (after 10 weeks gestation for surgical or medical abortions)
- Miscarriage
- Chorionic Villus Sampling (CVS)
- Ectopic pregnancy
- Molar pregnancy
- Exceptions: Insufficient evidence for Anti-D in threatened miscarriage before 12 weeks gestation unless bleeding is repeated, heavy, associated with abdominal pain, or significant pelvic trauma.
- Source: National Blood Authority Guidelines 2021
Second and Third Trimester (Basic Dose 625 IU)
- Obstetric haemorrhage
- Amniocentesis or other invasive fetal interventions
- External cephalic version of a breech presentation (successful or not)
- Abdominal trauma or suspected intra-uterine bleeding or sensitising event
- Abortion
Recommendation 2
- Prophylactic Dose: Rh(D) negative women (without preformed Anti-D) should be offered 625 IU Anti-D at approximately:
- 28 weeks gestation
- 34 weeks gestation
Recommendation 3
- Post-Delivery: All women who deliver an Rh(D) positive baby should have quantification of fetomaternal haemorrhage to guide the appropriate dose of Anti-D prophylaxis.
- Timing: Anti-D should be administered within 72 hours if possible.
Good Practice Point
- Administration Method: Anti-D should be administered as a deep intramuscular injection. For women with high BMI, this is often best achieved using the deltoid muscle.
Recommendation 5
- Prior to Anti-D Administration: Blood should be taken for Rh(D) antibody titre to detect preformed Anti-D.
Recommendation 6
- Omission of Test at 34 Weeks: The test may be omitted if prophylactic Anti-D was given at 28 weeks.
Recommendation 7
- Exclusion: Rh(D) immunoglobulin should not be given to women with preformed Anti-D antibodies unless due to antenatal administration of Rh(D) immunoglobulin.
Recommendation 8
- Unclear Anti-D Status: If uncertain whether Anti-D in the mother’s blood is passive or preformed, check patient records and/or consult treating clinician. If still in doubt, administer Rh(D) immunoglobulin.
Recommendation 9
- Post-First Trimester Events: All women given Anti-D after a potentially sensitizing event in the second or third trimester should have the magnitude of potential fetomaternal haemorrhage assessed.
- Further Administration: Administer additional Anti-D if necessary. If more than four doses are required, consider using the intravenous route for subsequent doses (e.g., Rhophylac).
| Timing | Recommendation | Grade |
|---|---|---|
| First Trimester | All Rh(D) negative women (without preformed Anti-D) should be offered 250 IU Anti-D in cases of: – Abortion (after 10 weeks gestation for surgical or medical abortions) – Miscarriage – Chorionic Villus Sampling (CVS) – Ectopic pregnancy – Molar pregnancy Exceptions: Insufficient evidence for Anti-D in threatened miscarriage before 12 weeks gestation unless bleeding is repeated, heavy, associated with abdominal pain, or significant pelvic trauma. Source: National Blood Authority Guidelines 2021 | C |
| Second Trimester | All Rh(D) negative women (without preformed Anti-D) should be offered 625 IU Anti-D in cases of: – Obstetric haemorrhage – Amniocentesis or other invasive fetal interventions – External cephalic version of a breech presentation (successful or not) – Abdominal trauma or suspected intra-uterine bleeding or sensitising event – Abortion | C |
| Prophylactic Dose: Rh(D) negative women (without preformed Anti-D) should be offered 625 IU Anti-D at approximately: – 28 weeks gestation | B | |
| Third Trimester | All Rh(D) negative women (without preformed Anti-D) should be offered 625 IU Anti-D in cases of: – Obstetric haemorrhage – Amniocentesis or other invasive fetal interventions – External cephalic version of a breech presentation (successful or not) – Abdominal trauma or suspected intra-uterine bleeding or sensitising event – Abortion | C |
| Prophylactic Dose: Rh(D) negative women (without preformed Anti-D) should be offered 625 IU Anti-D at approximately: – 34 weeks gestation | B | |
| Omission of Test at 34 Weeks: The test may be omitted if prophylactic Anti-D was given at 28 weeks. | Consensus-based recommendation | |
| Post-First Trimester Events: All women given Anti-D after a potentially sensitizing event should have the magnitude of potential fetomaternal haemorrhage assessed. Further Administration: Administer additional Anti-D if necessary. If more than four doses are required, consider using the intravenous route for subsequent doses (e.g., Rhophylac). | Consensus-based recommendation | |
| Post-Delivery | Post-Delivery: All women who deliver an Rh(D) positive baby should have quantification of fetomaternal haemorrhage to guide the appropriate dose of Anti-D prophylaxis. Timing: Anti-D should be administered within 72 hours if possible. | B |
| General Recommendations | Administration Method: – Anti-D should be administered as a deep intramuscular injection. – For women with high BMI, this is often best achieved using the deltoid muscle. | Consensus-based recommendation |
| Prior to Anti-D Administration: – Blood should be taken for Rh(D) antibody titre to detect preformed Anti-D. | Consensus-based recommendation | |
| Exclusion: – Rh(D) immunoglobulin should not be given to women with preformed Anti-D antibodies unless due to antenatal administration of Rh(D) immunoglobulin. | Consensus-based recommendation | |
| Unclear Anti-D Status: – If uncertain whether Anti-D in the mother’s blood is passive or preformed, – check patient records and/or consult treating clinician. – If still in doubt, administer Rh(D) immunoglobulin. | Consensus-based recom |