Prevention of Rh D Alloimmunization
Publication Date: August 1, 2017
Last Updated: March 14, 2022
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
Overview
Title
Prevention of Rh D Alloimmunization
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
August 1, 2017
Last Updated Month/Year
January 5, 2023
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