Prevention of Rh D Alloimmunization

Publication Date: August 1, 2017

Recommendations

Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery. (A)
574
Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive. (B)
574
External cephalic version (regardless of success) is associated with a 2–6% risk of fetal–maternal hemorrhage, and anti-D immune globulin is indicated for unsensitized Rh D-negative patient. (C)
574
It is reasonable to administer anti-D immune globulin to Rh D-negative women who are suspected of molar pregnancy and who undergo uterine evacuation. (C)
574
Although the risk of alloimmunization is low, the consequences can be significant, and administration of Rh D immune globulin should be considered in cases of spontaneous first-trimester miscarriage, especially those that are later in the first trimester. (C)
574
Because of the higher risk of alloimmunization, Rh D-negative women who have instrumentation for their miscarriage should receive Rh D immune globulin prophylaxis. (C)
574
Rh D immune globulin should be given to Rh D-negative women who have pregnancy termination, either medical or surgical. (C)
574
Administration of Rh D immune globulin for all cases of ectopic pregnancy in Rh D-negative women is recommended. (C)
574
Anti-D immune globulin is recommended for Rh D-negative women who experience antenatal hemorrhage after 20 weeks of gestation. (C)
574
Anti-D immune globulin should be administered to Rh D-negative women who have experienced abdominal trauma. (C)
574
Anti-D immune globulin should be administered to Rh D-negative women who experience fetal death in the second or third trimester. (C)
574

Recommendation Grading

Disclaimer

Overview

Title

Prevention of Rh D Alloimmunization

Authoring Organization

Publication Month/Year

August 1, 2017

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Ambulatory

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D012203 - Rh Isoimmunization

Keywords

Alloimmunization, Rh D, Rh D immune globulin