A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus-negative

Chilcott, Jim; Jones, Norman; Wight, Jeremy; Forman, Katie; Wray, Julie; Beverley, Catherine; Tappenden, Paul

doi:10.3310/hta7040

Cited by 150 publications

(82 citation statements)

References 48 publications

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“…There is strong evidence that RAADP is effective in the prevention of RhD immunisation. [8]–[11] Anti-D prophylaxis consists of pooled polyclonal anti-D IgG from human plasma donors. Generally, RAADP has been administered to all RhD negative women, even though 40 percent will carry a compatible RhD negative fetus, and so are not at risk for RhD immunisation.…”

Section: Introductionmentioning

confidence: 99%

Targeted Routine Antenatal Anti-D Prophylaxis in the Prevention of RhD Immunisation - Outcome of a New Antenatal Screening and Prevention Program

et al. 2013

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ObjectiveTo estimate the incidence of RhD immunisation after implementation of first trimester non-invasive fetal RHD screening to select only RhD negative women carrying RHD positive fetuses for routine antenatal anti-D prophylaxis (RAADP).Materials and MethodsWe present a population-based prospective observational cohort study with historic controls including all maternity care centres and delivery hospitals in the Stockholm region, Sweden. All RhD negative pregnant women were screened for fetal RHD genotype in the first trimester of pregnancy. Anti-D immunoglobulin (250–300 µg) was administered intramuscularly in gestational week 28–30 to participants with RHD positive fetuses. Main outcome measure was the incidence of RhD immunisation developing during or after pregnancy.ResultsDuring the study period 9380 RhD negative women gave birth in Stockholm. Non-invasive fetal RHD genotyping using cell-free fetal DNA in maternal plasma was performed in 8374 pregnancies of which 5104 (61%) were RHD positive and 3270 (39%) RHD negative. In 4590 pregnancies with an RHD positive test the women received antenatal anti-D prophylaxis. The incidence of RhD immunisation in the study cohort was 0.26 percent (24/9380) (95% CI 0.15–0.36%) compared to 0.46 percent (86/18546) (95% CI 0.37 to 0.56%) in the reference cohort. The risk ratio (RR) for sensitisation was 0.55 (95% CI 0.35 to 0.87) and the risk reduction was statistically significant (p = 0.009). The absolute risk difference was 0.20 percent, corresponding to a number needed to treat (NNT) of 500.ConclusionsUsing first trimester non-invasive antenatal screening for fetal RHD to target routine antenatal anti-D prophylaxis selectively to RhD negative women with RHD positive fetuses significantly reduces the incidence of new RhD immunisation. The risk reduction is comparable to that reported in studies evaluating the outcome of non selective RAADP to all RhD negative women. The cost-effectiveness of this targeted approach remains to be studied.

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Section: Introductionmentioning

confidence: 99%

Targeted Routine Antenatal Anti-D Prophylaxis in the Prevention of RhD Immunisation - Outcome of a New Antenatal Screening and Prevention Program

et al. 2013

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“…The most commonly used protocols involve 1500 IU of anti-D in gestational week 28 or 500 IU in weeks 28 and 34, followed by 1500 IU after delivery of an RhD-positive child. 43 Pooled data from 2 nonrandomized, community-based studies in England and Wales 44,45 suggest that antenatal RhD prophylaxis may reduce the sensitization rate from 0.95% (95% confidence interval [CI], 0.18Y1.71) to 0.35% (95% CI, 0.29Y0.40). This gives an odds ratio for the risk of sensitization of 0.37 (95% CI, 0.21Y0.65) and an absolute reduction in risk of sensitization in RhD-negative mothers at risk (ie, carrying an RhDpositive child) of 0.6%.…”

Section: Challenges Related To Rhd Prophylaxismentioning

confidence: 99%

“…This gives an odds ratio for the risk of sensitization of 0.37 (95% CI, 0.21Y0.65) and an absolute reduction in risk of sensitization in RhD-negative mothers at risk (ie, carrying an RhDpositive child) of 0.6%. 43 As approximately 36% of all RhD-negative women will give birth to an RhD-negative child, these women will receive antenatal anti-D unnecessarily. This is an ethical problem because these women are exposed to the risks, albeit small, associated with administration 529 Mechanisms and Prevention of Alloimmunization & CME Review Article of plasma derived anti-D.…”

Section: Challenges Related To Rhd Prophylaxismentioning

confidence: 99%

Mechanisms and Prevention of Alloimmunization in Pregnancy

Kjeldsen‐Kragh¹,

Skogen²

2013

Obstetrical &Amp; Gynecological Survey

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Transfusion only occasionally gives rise to antibody production, because blood cells per se are not markedly immunogenic. However, the immunological changes that occur during pregnancy increase the risk of alloimmunization against red blood cells, platelets, and/or leukocytes. Fetal-maternal bleeding during pregnancy or in relation to delivery is the antigenic stimuli for immunization against red blood cells, whereas other mechanisms, such as trophoblast-derived microparticles, may also play a role in the production of antibodies against platelets. Antibody-mediated immune suppression has for 4 decades successfully been used for prevention of RhD immunization. Result from a mouse model of fetal and neonatal alloimmune thrombocytopenia (FNAIT) suggests that the same principle may be applied for the prevention of FNAIT. A European Union-funded consortium is presently in the process of developing a hyperimmune anti-human platelet antigen 1a (HPA-1a) immunoglobulin G. The idea is to prevent HPA-1a immunization by administering the drug to nonimmunized HPA-1a-negative women after delivery of an HPA-1a-positive child. The anti-HPA-1a will be purified from plasma collected from women who previously have given birth to a child with FNAIT caused by anti-HPA-1a. If the results of the planned phase III trial are favorable, it is possible that a product for prevention of FNAIT will be available within this decade.

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“…When D negative patients are systematically injected at 28 weeks of pregnancy, the residual risk is further reduced by more than 60% [7].…”

Section: Introductionmentioning

confidence: 99%

Anti-D Prophylaxis Reviewed in the Erea of Foetal RHD Genotyping

Minon¹,

Gerard²,

Chantraine

et al. 2015

J Blood Disord Transfus

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A few years ago, the prevention of anti-D immunization was currently based on systematic postnatal prophylaxis associated with targeted antenatal injection in high-risk situations of foeto-maternal haemorrhage. The failures of prevention are mainly due to the non-respect of established guidelines for RhIG prophylaxis, and to spontaneous undetected foetal-maternal haemorrhages without any obvious cause during the third trimester of pregnancy.In order to reduce the rate of residual post-pregnancy anti-D immunization, several countries decided to associate the classical prophylaxis to a routine antenatal anti-D prophylaxis (RAADP) during the 28th or 29th week of gestation. Since about ten years, the foetal RHD genotyping in maternal plasma enables us to limit the antenatal prophylaxis only to those D-women carrying a D+ foetus. This paper deals with: the advantages of an antenatal prevention in the light of non invasive foetal RHD genotyping, the rules rendering prevention protocols efficient whatever the algorithm applied, and the recommended immuno-haematology follow-up of women who have received RhIG.

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A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus-negative

Cited by 150 publications

References 48 publications

Targeted Routine Antenatal Anti-D Prophylaxis in the Prevention of RhD Immunisation - Outcome of a New Antenatal Screening and Prevention Program

Targeted Routine Antenatal Anti-D Prophylaxis in the Prevention of RhD Immunisation - Outcome of a New Antenatal Screening and Prevention Program

Mechanisms and Prevention of Alloimmunization in Pregnancy

Anti-D Prophylaxis Reviewed in the Erea of Foetal RHD Genotyping

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