Rhesus D prophylaxis in pregnancy

This guideline is very relevant to us. Nothing has really changed, but it reiterates best practice. It applies to non-sensitised women (ie who don’t have anti-D antibodies on their booking bloods):

When would we need to give it?

Most of the time (eg terminations / evacuation of products etc), anti-D will be given in secondary care. The following times may require us to give it / organise it. If in doubt, check:

  • Miscarriages – threatened, complete or incomplete miscarriage after 12/40, or where there is heavy or repeated bleeding just before 12/40. NB – you don’t have to give it under 12/40 for a complete miscarriage where no intervention has been required, as the risk of sensitisation is low.
  • Abdominal trauma – any abdominal trauma at any gestation
  • Recurrent bleeding after 20/40 (though I would have expected these women to be in secondary care).
  • Routine prophylaxis (28/40 and 34/40 – their antibodies are checked at 28/40)

How do we give it?

  • See the BNF for how to give it and doses.
  • It should be given within 72 hrs – but can be helpful up to 10d after the event.
  • Give it irrespective of routine prophylaxis and vice-versa.
  • After 20/40, always do a Kleiheuer as well (but these women should be under secondary care).
  • If the woman refuses, document the advice given and provide a PIL. Follow-up the woman to check if she has become sensitised.
If you're referring to this during a consultation, let us know how useful you've found this!

 

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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