Routine anti-D prophylaxis for RhD-negative pregnant women

Abstract

Haemolytic disease of the newborn affects about 500 fetuses in England and Wales annually, and kills 25-30. In 1999, the Royal College of Obstetricians and Gynaecologists published guidelines recommending routine antenatal anti-D prophylaxis of at least 500 IU at 28 and 34 weeks’ gestation for all Rhesus D (RhD)-negative women. This recommendation has been confirmed by the National Institute for Clinical Excellence, which outlines the rationale behind its decision, and the issues that should be discussed with each eligible woman. Midwives are the primary providers of antenatal care for most pregnant women. As such, they are likely to be the most important source of information for women eligible to receive antenatal anti-D prophylaxis. By setting out the scientific basis of alloimmunization with RhD antigen, this article will put midwives in a position to reassure women who are not at risk. This article also aims to summarize the issues concerned and their relative importance, and to provide the midwife with the information she needs to offer every women the opportunity to make a fully informed decision about routine antenatal anti-D prophylaxis.