Adherence to Rh Immune Globulin Prophylaxis Guidelines: An Audit of a Modern Obstetric Cohort [34Q

Abstract

INTRODUCTION: There is excellent evidence for postpartum Rh immune globulin (RhIG) prophylaxis efficacy and effectiveness. Continued adherence to RhIG prophylaxis guidelines is essential in preventing Rh alloimmunization and hemolytic disease of the newborn. This study aimed to perform an audit of RhIG prophylaxis practice in a modern obstetric cohort. METHODS: A retrospective chart review of 451 consecutive deliveries of Rh-negative women at a single-site tertiary medical center was performed. Fisher exact test was used for statistical analysis. RESULTS: The prevalence of Rh negativity was 8.9%. Of the Rh-negative women eligible to receive postpartum RhIG, 97.7% received RhIG and 98.9% were screened for fetomaternal hemorrhage (FMH). Of the Rh-negative women ineligible for RhIG administration, 4.6% inappropriately received RhIG and 91.9% were incorrectly screened for FMH. Evidence of FMH was demonstrated in 26.6% of Rh-negative women. Additionally, 1.7% of Rh-negative women had evidence of excessive FMH requiring additional administration of RhIG. Patients with FMH were more likely to have evidence of maternal acute blood loss anemia (47.8% versus 32.9%, P < .05). Mode of delivery was not associated with increased likelihood of FMH (P=.4). CONCLUSION: This audit revealed two key areas for improvement. First, the widespread practice of ordering an unnecessary laboratory test was identified. Second, the rates of failure to order RhIG and FMH screening were determined. Though multiple factors likely contribute to imperfect adherence to guidelines, RhIG prophylaxis has historically been physician-driven at our institution. Implementing a protocol-driven approach may improve adherence; however, further study will be necessary to determine a superior approach.