Antenatal prophylaxis of Rh immunization with 250 μg anti‐D immunoglobulin

A review of the clinical effectiveness of routine antenatal anti‐D prophylaxis for rhesus‐negative women who are pregnant

“…In some instances, this may have been due to the dose or schedule used. A study 16 which offered antenatal anti‐D prophylaxis only at 34 weeks found that this was too late for routine prophylaxis as some women were already isoimmunised by that date; in this study, the sensitisation rate in primigravid primiparae was identical in both arms. In another study, 24 the proportion of isoimmunised women was very similar in both groups; no explanation was offered for this but, as the intervention and control groups came from different continents, the results may reflect different obstetric practices.…”

“…Although one 15 purported to describe the results of a province‐wide programme of antenatal prophylaxis, it only presented results for those women who actually received such prophylaxis (only 89% of those at risk). Three other studies screened women for antibodies prior to inclusion, but did not state how many were excluded from the study as a result 16,19,20 . At least one of these studies 19 also excluded from the intervention group, but apparently not from the control group, women who were sensitised between the first antibody screen test in the first trimester and the 28th gestational week; another 16 excluded from its analysis women in the intervention group who were sensitised before receiving prophylaxis.…”

“…Clinically, the most important outcome measure is the number of women found to be sensitised in a subsequent pregnancy. Only five studies 1,14,16,21,22 provided this information, and only three of these 1,21,22 provided such data for the control group as well as the intervention group.…”

Fetal–Maternal Hemorrhage Detected by Sudden Disappearance of Rh Immune Globulin–Related Anti-D

“…Although maternally administered Rh immune globulin does cross the placenta and can interact with fetal cells to produce a positive direct antiglobulin test result, Rh immune globulin does not pose a significant risk of fetal anemia. 2,3 Though in this case we cannot directly attribute the anemia as the cause of the atrial flutter, isolated atrial flutter has been associated with neonatal anemia. 4 A case series of nine neonates with isolated atrial flutter diagnosed perinatally revealed five to have relative anemia (hemoglobin between 8.0 and 12.7 g/dL) for gestational age at birth.…”

RhOD immune globulin products for prevention of alloimmunization during pregnancy

“…A summary of additional studies of antenatal prophylaxis with RhIG is included in Table 2. 25,[35][36][37][38][39][40][41][42][43] Turner et al 44 performed a biasadjusted meta-analysis of available studies of routine antenatal prophylaxis with RhIG, finding that prophylaxis was highly effective at preventing alloimmunization, with a pooled odds ratio for Rh sensitization among treated women of 0.31 (95% confidence interval [CI], 0.17-0.56). Additional analyses were performed in an effort to identify the most effective dosing scheme.…”