Prenatal Rh‐Immune Prophylaxis With 300 μg Immune Globulin Anti‐D In The 28th Week Of Pregnancy

Abstract

As immune globulin anti-D given in the immediate post partum period fails to prevent the development of anti-D antibodies in about 1.5-2% of women at risk, probably as a result of feto-maternal bleeding during pregnancy, 300 micrograms of immune globulin anti-D was administered to 609 Rh-negative women in the 28th gestational week. Three hundred and forty-six had Rh-positive babies, and were given additionally 200 micrograms anti-D post partum. Of these, 291 had an antibody screen test done 10 months after delivery. No anti-D antibodies were found. The test results of the study group were compared with those of a control group of 354 women who did not receive prenatal immune globulin, but otherwise the same examinations and treatment. In this group, 322 had a screen test performed 10 months post partum or in their next pregnancy, when 1.8% had anti-D antibodies. The difference in immunization incidence between the groups was significant (p less than 0.05). There was no difference between the groups regarding the number of women with fetal erythrocytes in serum after delivery, but the number of fetal erythrocytes found was significantly lower in the group receiving prenatal prophylaxis (p less than 0.001). No adverse effects were found in the infants exposed to anti-D prenatally.

Routine Antenatal Anti-D Prophylaxis in Women Who Are Rh(D) Negative: Meta-Analyses Adjusted for Differences in Study Design and Quality

“…The first NICE appraisal identified 10 studies which compared RAADP to control [6]–[15]. The second appraisal identified only one new relevant study, which compared intravenous against intramuscular delivery of the same dose of RAADP.…”

“…The NICE appraisals identified 10 studies which evaluated the clinical effectiveness of RAADP compared to control [6]–[15]. However, the studies were generally of poor quality and varied substantially in study design.…”

General obstetrics: The kinetics of routine antenatal prophylactic intramuscular injections of polyclonal anti‐D immunoglobulin

“…The optimum schedule for antenatal prophylaxis is still unclear, with two approaches having been developed including a single injection of 1500 IU at 28 weeks of gestation [1][2][3] or two injections of 500 IU at 28 weeks and again at 34 weeks of gestation. [4][5][6] Theoretically, the protocol using two injections has the potential benefit that prophylactic anti-D levels in the maternal circulation at term will be slightly higher than with the single injection protocol; the recent NICE guidance on routine antenatal prophylaxis has recommended the two injection strategy for all non-immunised RhD-negative women.…”

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.…”