Quality audit of the guidelines for the use of RhD immunoglobulin in obstetrics: Are we getting it right?

Abstract

Administration of RhD immunoglobulin (Ig) is important for RhD negative women throughout pregnancy and postnatally to prevent alloimmunisation and haemolytic disease of the fetus and newborn in subsequent pregnancies. The aim of this audit was to understand compliance with the Australian guidelines on RhD Ig prophylaxis in pregnancy. This was a retrospective audit of RhD negative pregnant women in Victoria, Northern Territory, Australian Capital Territory and Tasmania at maternity services of level 2 or higher care, between July 2017 and June 2018. Medical records were reviewed to identify how many RhD negative women received care compliant with the guidelines covering antibody testing, consent, administration of RhD Ig, and feto-maternal haemorrhage (FMH) quantification. Analysis included 939 RhD negative women from 43 health services. Compliance with postnatal RhD Ig was high (98%); however, other practice was poor. Documented consent was obtained and recorded for 585 women (62%). Only 76% of eligible women received RhD Ig at the appropriate dose and time (28 and 34weeks gestation). Similarly, management of potentially sensitising events was suboptimal with 78% receiving RhD Ig when recommended by guidelines. The results of our audit indicate a need for practice improvement across all aspects of care for women who need to receive RhD Ig. A major focus should be not just educating clinical staff, but also educating women to understand the importance of RhD Ig and the potential impact on subsequent pregnancies in order to improve guideline adherence and reduce risk.