Rh(D) Incompatibility: Screening -- Unsensitized Rh(D)-negative pregnant women


General

Grade: B

Specific Recommendations

The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative.

Frequency of Service

Repeat testing at 24-28 weeks gestation.

Risk Factor Information

No information available.


Clinical

Clinical Considerations

  • Administration of a full (300 µg) dose of Rh(D) immunoglobulin is recommended for all unsensitized Rh(D)-negative women after repeated antibody testing at 24 to 28 weeks' gestation.
  • If an Rh(D)-positive or weakly Rh(D)-positive (e.g., Du-positive) infant is delivered, a dose of Rh(D) immunoglobulin should be repeated postpartum, preferably within 72 hours after delivery. Administering Rh(D) immunoglobulin at other intervals after delivery has not been studied.
  • Unless the biological father is known to be Rh(D)-negative, a full dose of Rh(D) immunoglobulin is recommended for all unsensitized Rh(D)-negative women after amniocentesis and after induced or spontaneous abortion; however, if the pregnancy is less than 13 weeks, a 50 µg dose is sufficient.
  • The benefit of routine administration of Rh(D) immunoglobulin after other obstetric procedures or complications such as chorionic villus sampling, ectopic pregnancy termination, cordocentesis, fetal surgery or manipulation (including external version), antepartum placental hemorrhage, abdominal trauma, antepartum fetal death, or stillbirth is uncertain due to inadequate evidence.

Rationale

Rationale

Specific Recommendation: The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.

Rationale: The USPSTF found good evidence that Rh(D) blood typing, anti-Rh(D) antibody testing, and intervention with Rh(D) immunoglobulin, as appropriate, prevents maternal sensitization and improves outcomes for newborns. The benefits substantially outweigh any potential harms.

Specific Recommendations: The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative.

Rationale: The USPSTF found fair evidence that repeated antibody testing for unsensitized Rh(D)-negative women (unless the father is also known to be Rh[D]-negative) and intervention with Rh(D) immunoglobulin, as appropriate, provides additional benefit over a single test at the first prenatal visit in preventing maternal sensitization and improving outcomes for newborns. The benefits of repeated testing substantially outweigh any potential harms.

The USPSTF found no new evidence addressing the role of screening, new screening tests, new treatment protocols, or potential harms associated with screening and treatment of Rh(D) incompatibility. However, there is pre-existing good evidence for the efficacy and effectiveness of blood typing, anti-Rh(D) antibody screening, and postpartum Rh(D) immunoglobulin prophylaxis.


Others

No information available.


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