Appropriate provision of anti-D prophylaxis to RhD negative pregnant women: a scoping review

Abstract

BackgroundThe purpose of this scoping review was to review the literature on healthcare provider provision of anti-D prophylaxis to RhD negative pregnant women in appropriate clinical situations in various healthcare settings.MethodsA scoping review framework was used to structure the process. The following databases were searched: CINAHL (EBSCO), EBM Reviews (OvidSP), Embase (OvidSP), Medline (OvidSP), and Web of Science (ISI). In addition, hand searching of article references was conducted. The search yielded 301 articles. Thirty-five articles remained for review after screening. Two team members reviewed each article using a detailed data collection sheet. A third reviewer was utilized if discrepancies occurred amongst reviewers.ResultsThe review process yielded 18 included articles. The majority of the studies were conducted in the United Kingdom. Of the 18 studies, 15 were retrospective studies. The articles were largely conducted in one institution. The articles with a focus on routine antenatal provision of anti-D immunoglobulin found that it was given 80 to 90% of the time. Postpartum provision of anti-D immunoglobulin had significantly higher results of 95-100%. The review found that the delivery of anti-D immunoglobulin to RhD negative pregnant women during situations of potential sensitizing events was suboptimal.ConclusionsThe included articles examine the management of RhD negative pregnancies in various countries with existing national guidelines. The existing evidence indicates an opportunity for quality improvement in situations where potential sensitizing events are not at routine times in pregnancy, such as miscarriage or fetal demise early in pregnancy. Routine care for the prevention of RhD alloimmunization in pregnancy and postpartum appears to be fairly consistent. The paucity of recent literature in this area leads to a recommendation for further research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0411-1) contains supplementary material, which is available to authorized users.

High-throughput non-invasive prenatal testing for fetal rhesus D status in RhD-negative women not known to be sensitised to the RhD antigen: a systematic review and economic evaluation

“…To inform other parameter estimates for this simulation, we conducted an additional literature search to identify relevant systematic reviews of antenatal anti-D prophylaxis. Four relevant reviews [61][62][63][64] were identified. These reviews provided data on the probability estimates of the events used in the simulation study, including sensitisation and compliance rates.…”

Prevention of RhD alloimmunization in Northern British Columbia

“…Any event that can cause a FMH is considered a sensitizing event. These clinical significant clinical events can lead to the potential development of D antibodies in an RhD negative pregnancy (Fyfe et al, 2014). The list of sensitizing events is substantial:…”

“…Even with the availability of RhIG, RhD negative women are still developing D-antibodies in pregnancy. Fyfe et al (2014), found that in various healthcare settings opportunities for RhD alloimmunization exist because of mismanagement of care; for example, the prophylaxis is not given and/or not given at the right time when a sensitizing event occurs. Absent from the literature are the reasons behind the occurrence risks of this patient safety incident.…”

“…Following the recommendations made in the Fyfe et al (2014)'s scoping review, the continued risk of RhD alloimmunization in pregnancy needs to be explored. In a scoping review of the literature, Fyfe et al (2014) suggested that research exploring the experiences of RhD negative women with pregnancy and further insight into healthcare provider experiences in the delivery of care may provide guidance into this problem. These suggestions provided direction for this study, specifically informing the following research questions:…”

“…After an informal complaint was made to the regional health authority, Northern Health (NH), the questions being asked led to the development of a stakeholder team of decision-makers at NH. This team conducted a scoping review (Fyfe et al, 2014) focused on adherence to RhD alloimmunization prevention guidelines. The scoping review provided the opportunity to further this project by asking questions that were derived from gaps in the literature.…”