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