Targeted antenatal anti‐D prophylaxis program for RhD‐negative pregnant women – outcome of the first two years of a national program in Finland

Haimila, Katri; Sulin, Kati; Kuosmanen, Malla; Sareneva, Inna; Korhonen, Anu; Natunen, Suvi; Tuimala, Jarno; Sainio, Susanna

doi:10.1111/aogs.13191

Cited by 44 publications

(57 citation statements)

References 16 publications

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“…5 National programs have now been implemented in Norway and Finland. 6,7 Implementation is currently being evaluated in England after the National Institute for Health and Care Excellence studied the issue for the National Health Service. 8 A national policy is being considered in Canada.…”

Section: Many European Countries However Chose Not To Introduce Antenmentioning

confidence: 99%

Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost‐effective in the United States?

Moise

Hashmi²,

Markham

et al. 2019

Prenatal Diagnosis

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What is already known about this topic? Cell free DNA can accurately predict the fetal RHD status. What does this study add? Use of cell free DNA to determine the fetal RHD status to triage the use of antenatal rhesus immune globulin is not a cost‐effective strategy for implementation in the United States. Universal rhesus antenatal immune globulin without consideration for paternity is the most effective strategy for preventing new cases of RhD alloimmunization.

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Section: Many European Countries However Chose Not To Introduce Antenmentioning

confidence: 99%

Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost‐effective in the United States?

Moise

Hashmi²,

Markham

et al. 2019

Prenatal Diagnosis

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“…Anti‐D prophylaxis has dramatically reduced the incidence of Rh(D) disease in Australia since its introduction in the 1960s . RAADP is now recommended for all non‐sensitised Rh(D)‐negative pregnant women and for those not predicted to be carrying Rh(D)‐negative fetuses by non‐invasive cell‐free fetal DNA RHD genotyping . RAADP regimens vary between countries, ranging from two doses of anti‐D of at least 500 IU each at 28 and 34 weeks of pregnancy to a single 1500 IU dose at 28 weeks .…”

mentioning

confidence: 99%

Single dose v two‐dose antenatal anti‐D prophylaxis: a randomised controlled trial

White

Cheng

Penova-Veselinovic

et al. 2019

Medical Journal of Australia

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Objective To compare rates of detectability of circulating Rh(D)‐immunoglobulin (anti‐D) at delivery with single and two‐dose antenatal anti‐D prophylaxis (RAADP) regimens; to compare compliance with the two regimens. Design Open label, randomised controlled trial between May 2013 and November 2015. Setting, participants 277 women who attended a tertiary obstetric referral hospital in Perth for antenatal care and were at least 18 years of age, less than 30 weeks pregnant and yet to receive RAADP, Rh(D)‐negative (negative antibody screen), and who intended to deliver their baby at the hospital. Exclusion criteria were prior anti‐D sensitisation, any contraindication of anti‐D administration, and a history of isolated IgA deficiency. Interventions One 1500 IU anti‐D dose at 28 weeks of pregnancy (single dose regimen); two doses of 625 IU each at 28 and 34 weeks of pregnancy (two‐dose regimen). Main outcome measures The primary outcome was the proportion of women with detectable anti‐D levels at delivery; the secondary outcome was compliance with the allocated RAADP regimen. Results Circulating anti‐D was detectable at delivery in a greater proportion of women in the two‐dose group (111 of 129, 86%) than in the single dose group (70 of 125, 56%; P < 0.001). Compliance was not significantly different between the single dose (86 of 138, 61%) and two‐dose groups (70 of 139, 50%; P = 0.06). Conclusions The two‐dose RAADP schedule currently recommended in Australia provides better protection against Rh(D) sensitisation than a one‐dose regimen. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12613000661774).

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“…This technique follows the consensus recommendation to include exon 5 [12,17,20,24], which, in combination with exon 10, helps to identify RHD- positive / D-positive subjects and to distinguish of RHD -positive / D-negative cases, mostly due to presence of the RHD pseudogen ( RHDψ ) or cases of hybrid RHD-CE-D s . Thus, this combination avoids false-positive results and also identifies some RHD variants [15]. …”

Section: Discussionmentioning

confidence: 99%

“…In the Netherlands, since July 1, 2011, both antenatal and postnatal prophylaxis are administered only to women in whom fetal RHD genotyping at gestational week 27 predicts a D-positive fetus [13,14]. As additional screening methods to guide IgRH prophylaxis, fetal RHD genotyping has also been implemented regionally in France, England, Finland, and Sweden [15,16] and will probably be used for diagnosis by many other countries in the future [17]. …”

Section: Introductionmentioning

confidence: 99%

Usefulness of Non-Invasive Fetal RHD Genotyping towards Immunoprophylaxis Optimization

Blanco

Giacomi²,

Slobodianiuk³

et al. 2018

Transfus Med Hemother

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Introduction: Since anti-D immunoprophylaxis given to D-negative pregnant women is a blood product, blood donations have an impact on the availability of prophylactic doses. The Pan American Health Organization reported, in June 2017, that less than half of blood donors are volunteers in Latin America and the Caribbean. In these countries, guidelines for use of anti-D prophylaxis are still controversial. The aim of this study was to demonstrate the convenience of a simple and cost-effectivene non-invasive prenatal diagnostic assay for anti-D prophylaxis optimization in multiethnic populations. Methods: Cell-free fetal DNA from plasma samples of D-negative pregnant women were analyzed by real-time PCR for simultaneous amplification of sequences of exons 5 and 10 of the RHD gene. Fetal RHD genotype was determined in 111 pregnant women. Neonates' phenotype was determined 72 h after birth. Results: Genotyping predicted fetal phenotype with 100% accuracy. Prenatal diagnosis showed 78% RHD-positive and 22% RHD-negative neonates. Conclusion: We demonstrated that, beyond the large genetic variation of the Rh system and the numerous D variants present in multiethnic groups, non-invasive fetal RHD genotyping using two sequences of the gene can be enough for clinical application in an admixed population. This robust technique of simple implementation allows to determine fetal RHD in maternal blood with high sensitivity, specificity, and accuracy. The introduction of fetal RhD genotyping as part of an antenatal screening program constitutes a reliable manner to optimize anti-D prophylaxis; however, it has not been implemented so far in most American countries.

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Targeted antenatal anti‐D prophylaxis program for RhD‐negative pregnant women – outcome of the first two years of a national program in Finland

Cited by 44 publications

References 16 publications

Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost‐effective in the United States?

Cell free fetal DNA to triage antenatal rhesus immune globulin: Is it really cost‐effective in the United States?

Single dose v two‐dose antenatal anti‐D prophylaxis: a randomised controlled trial

Usefulness of Non-Invasive Fetal RHD Genotyping towards Immunoprophylaxis Optimization

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