Society of Family Planning committee consensus on Rh testing in early pregnancy

Is it time to reconsider Rh testing and Rh D immune globulin treatment for miscarriage and abortion care in early pregnancy?

“…"For patients under 12 weeks gestation, although not recommended, Rh testing and Rh D immune globulin administration may be considered at patient request as part of a shared decision making process." 16 In 2022, the World Health Organization (WHO) reported "There are few studies examining Rh isoimmunization in unsensitized Rh-negative individuals seeking abortion before 12 weeks of gestation. " "The evidence on the effectiveness of the intervention may favor the intervention, because fewer women in the intervention group (anti-D administration) had antibody formation after the initial pregnancy compared to women in the comparison group (no anti-D) and no harms (undesirable effects) of the intervention were noted. "…”

“…• the Kleihauer-Betke technique cannot distinguish between maternal red blood cells expressing fetal hemoglobin (maternal F cells) and fetal cells, which has resulted in the over-estimation of the number of fetal cells in the maternal circulation 20 • using a dual-label flow cytometry method that distinguishes maternal F cells and fetal red blood cells, maternal F cells usually far outnumber fetal red blood cells in the maternal circulation in the first trimester 20 • among women in the first trimester undergoing uterine aspiration, the number of fetal cells in the maternal circulation is very low both before and after the procedure 20 • Rh testing and Rh immune globulin administration is burdensome and expensive. 16…”

“…22 Based on recent studies demonstrating a low number of fetal red blood cells in the maternal circulation in the first trimester, family planning specialists are reducing the use of Rh testing and Rh immune globulin administration in both early pregnancy medication abortion and uterine aspiration abortion. 16 With regard to Rh testing and Rh D immune globulin treatment, the future will definitely be different than the past. It is likely that many clinicians will reduce the use of Rh testing and Rh D immune globulin treatment in patients with miscarriage or induced abortion in early pregnancy.…”

Use of Rh Immune Globulin in First-Trimester Abortion and Miscarriage

“…Although the specific cost of this practice is poorly understood, Rh immune globulin alone costs $80 or more-and this does not reflect additional equipment or insurance costs. 5 It is difficult to incorporate cost estimates for the management of patients who are Rh sensitized in subsequent pregnancies, because these costs have not been fully estimated in the United States and the likelihood of alloimmunization is low for patients who experience first-trimester bleeding. 20 Even when patients have a recorded blood type in the medical record, checking their Rh status generates administrative burdens that occupy the time and attention of physicians and support staff.…”

Use of Rh Immune Globulin in First-Trimester Abortion and Miscarriage

“…Although the Society of Family Planning has promoted the position that Rh typing and Rh immune globulin are not recommended in cases of any abortion (spontaneous, medically induced, or uterine aspiration) before 12 weeks of gestation, the American College of Obstetricians and Gynecologists' position is that it still should be undertaken but not hinder access to care. 4,5…”