Objectives To reduce the risk of RhD alloimmunization during the last trimester of pregnancy, a targeted routine antenatal anti‐D prophylaxis (RAADP) programme was implemented in Norway in 2016. Here, we present and discuss our experience with the nationwide implementation of the programme, and report sample uptake and preliminary data of de novo anti‐D in pregnancy. Background The targeted RAADP was advised by the academic community and evaluated by the health authorities. A National Working Group has conducted the implementation in the transfusion services and contributed to organise the administration of the antenatal anti‐D prophylaxis. Fetal RhD type is determined by non‐invasive prenatal testing at gestational week 24, and anti‐D prophylaxis is administrated at gestational week 28 only to women with RhD positive fetuses. Methods We describe the implementation process of targeted RAADP in Norway. The sample uptake is calculated by comparing the number of fetal RHD screens with the expected number of samples. Results The sample uptake shows regional variations: 88%–100% after 3 years. Promising decrease in de novo anti‐D detected during pregnancy is observed. Conclusions Nationwide targeted RAADP is implemented and included in the Norwegian maternity care programme. Compliance to sample uptake should further improve in some regions. A remaining issue to fulfil is the documentation of the accuracy of the fetal RHD‐typing at all sites. Post‐natal prophylaxis will then be guided by the fetal RHD result. Dedicated registries will ensure data to evaluate the expected reduction in pregnancy‐related RhD immunisations, which is the final success criterion of the programme.

Introduction In September 2016, a nationwide targeted routine antenatal anti‐D prophylaxis program was implemented in Norway. The prophylaxis (anti‐D immunoglobulin) aims to cover the whole third trimester and is administered in gestational week 28 to RhD‐negative women who carry RhD‐positive fetuses. However, in many women, antibody screening at delivery does not detect anti‐D immunoglobulin. The goal of this study was to investigate the presumable role of dose and timing of antenatal anti‐D immunoglobulin administration in non‐detectable prophylaxis at the time of delivery. Material and methods In this retrospective observational study, RhD‐negative pregnant women who gave birth at Oslo University Hospital and Akershus University Hospital between January 2017 and December 2019 were analyzed. Women who received antenatal anti‐D immunoglobulin (1500 IU at Oslo University Hospital and 1250 IU at Akershus University Hospital) when fetal RHD genotyping at gestational week 24 predicted an RhD‐positive fetus were included if an antibody screen at delivery was available. Data from the blood bank, maternity information systems, and electronic patient records were used. Results Analysis of the 984 RhD‐negative women at the two hospitals revealed that 45.4% had non‐detectable anti‐D at delivery. A significant difference between the two hospitals was observed: 40.5% at Oslo University Hospital (n = 509) and 50.7% at Akershus University Hospital (n = 475) (p = 0.001). The proportion with non‐detectable anti‐D increased to 56.0 and 75.3%, respectively (p = 0.008) in the group of women who gave birth 12 weeks after routine antenatal anti‐D prophylaxis. Significantly fewer women had detectable anti‐D at delivery when the lower anti‐D immunoglobulin dose (1250 IU) was administered antenatally. Multiple logistic regression indicated that the time interval between routine antenatal anti‐D prophylaxis and delivery, in addition to anti‐D dose, were significantly associated with detectable anti‐D at delivery (p < 0.001). Conclusions We do not know which RhD‐negative pregnant women, despite antenatal anti‐D prophylaxis, are at risk of RhD alloimmunization, when antibody screening is negative at delivery. Administration of antenatal prophylaxis should probably be moved closer to delivery, since the risk of fetomaternal hemorrhage is higher during the last weeks of the third trimester.