Materiały źródłowe

• #1 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  The subsequent passage outlines the prevention and prophylaxis of Rhesus disease: […] Before 1945, about 50% of all foetuses with HDN died of kernicterus or hydrops foetalis. Subsequently, thanks to the progress in treatment, in industrialised countries the mortality decreased to 23%; this mortality rate was then very considerably further reduced (100-fold) with the introduction of anti-D immunoprophylaxis to prevent maternal-foetal anti-Rh(D) alloimmunisation. […] At the beginning of the 1960s, Stern demonstrated experimentally that the administration of anti-D IgG could prevent sensitisation to the Rh(D) antigen; in the same period, other studies clarified the mechanism of Rh iso-immunisation in pregnancy and introduced the clinical practice of passive immunisation with anti-D IgG to protect Rh(D)-negative women from sensitisation against Rh(D)-positive red blood cells.

• #2

  https://www.nhs.uk/conditions/rhesus-disease/prevention/

  Rhesus disease can largely be prevented by having an injection of a medication called anti-D immunoglobulin. […] Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative. This routine administration of anti-D immunoglobulin is called routine antenatal anti-D prophylaxis, or RAADP (prophylaxis means a step taken to prevent something from happening). […] RAADP is recommended for all pregnant RhD negative women who haven’t been sensitised to the RhD antigen, even if you previously had an injection of anti-D immunoglobulin. […] After giving birth, a sample of your baby’s blood will be taken from the umbilical cord. If you’re RhD negative and your baby is RhD positive, and you haven’t already been sensitised, you’ll be offered an injection of anti-D immunoglobulin within 72 hours of giving birth. This means your blood won’t have a chance to produce antibodies and will significantly decrease the risk of your next baby having rhesus disease. […] However, the evidence in support of RAADP shows that the benefits of preventing sensitisation far outweigh these small risks.

• #3 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  Prophylaxis of alloimmunization by Rh (D) antigen is performed by administration of anti-Rh (D) immunoglobulin [IgRh (D)]. […] Immunoglobulin administration is indicated in the postpartum period of Rh-negative, non-sensitized women (negative indirect Coombs test) whose neonate is Rh-positive. […] Gestational prophylaxis is also indicated for events that increase the risk of fetal-maternal hemorrhage, such as: Abortion; First trimester bleeding; Hydatidiform mole pregnancy; Ectopic pregnancies; Invasive procedures (chorionic villus sampling, amniocentesis, fetal surgery); Stillbirth; Hemorrhages of the second and third trimesters; Abdominal trauma; External version. […] IgRh (D) (300 g) should be administered within 72 hours after delivery, although some efficacy is reported up to 28 days postpartum.

• #4 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #5 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Introduction of anti-Rh(D) immunoglobulin more than 50 years ago, has only resulted in a 50% decrease of Rhesus (Rh) Disease globally, due to a low uptake of this prophylaxis. […] In 2021 the Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention of Rh Disease by immunoprophylaxis, considering the cost effectiveness of the different dose regimens and prioritizing its administration by indication. […] Practice recommendations: measures to prevent sensitization to Rh(D). […] First priority: Determine the maternal Rh factor, preferably in early pregnancy. […] Give Anti-Rh(D) immunoglobulin within 72 hours after birth to women who have delivered Rh-positive newborns, unless already sensitized. […] Routine Anti-Rh(D) prophylaxis during pregnancy: 1,500 IU (300 g) at 28-34 weeks.

• #6 Prevention of Rh D Alloimmunization | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/08/prevention-of-rh-d-alloimmunization

  ABSTRACT: Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 1316% to approximately 0.51.8%. The risk was further reduced to 0.140.2% with the addition of routine antepartum administration. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization.

• #7

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181_summary__prevention_of.48.aspx

  Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 13-16% to approximately 0.5-1.8%. […] Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery. […] Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive.

• #8 Rh disease – Wikipedia

  https://en.wikipedia.org/wiki/Rh_disease

  The protection that is offered today against Rh incompatibility involved preventive measures that primarily utilize Rh immunoglobulin, also known as RhoGAM. The aim of these treatments are to prevent the mother’s immune system from becoming sensitized to the Rh antigen, which reduces the risk of hemolytic disease in future pregnancies. RhoGAM, Rh immunoglobulin administration, is a product that contains antibodies to the Rh(D) antigen; it is used to prevent the mother from developing an immune response to fetal red blood cells. RhIg 'coats’ any Rh-positive fetal red blood cells that enter the mothers bloodstream, effectively 'hiding’ them from the mother’s immune system. RhoGAM is typically administered at around 28 weeks of pregnancy, then again within 72 hours after childbirth. It is also given during other events that happen during pregnancy like miscarriages, ectopic pregnancies, amniocentesis, and abdominal trauma.

• #9 Rh disease – Wikipedia

  https://en.wikipedia.org/wiki/Rh_disease

  The protection that is offered today against Rh incompatibility involved preventive measures that primarily utilize Rh immunoglobulin, also known as RhoGAM. The aim of these treatments are to prevent the mother’s immune system from becoming sensitized to the Rh antigen, which reduces the risk of hemolytic disease in future pregnancies. RhoGAM, Rh immunoglobulin administration, is a product that contains antibodies to the Rh(D) antigen; it is used to prevent the mother from developing an immune response to fetal red blood cells. RhIg 'coats’ any Rh-positive fetal red blood cells that enter the mothers bloodstream, effectively 'hiding’ them from the mother’s immune system. RhoGAM is typically administered at around 28 weeks of pregnancy, then again within 72 hours after childbirth. It is also given during other events that happen during pregnancy like miscarriages, ectopic pregnancies, amniocentesis, and abdominal trauma.

• #10 Prevention of rhesus disease – GPnotebook

  https://gpnotebook.com/pages/obstetrics/prevention-of-rhesus-disease

  It is important to identify at risk pregnancies (Rhesus (Rh) negative women). […] anti-rhesus (anti-D) immunoglobulin should be given after delivery to all Rh-negative women where the baby’s blood group cannot be determined (e.g. if macerated stillbirth). Also anti-D should be given to Rh-negative mothers following the birth of a Rh-positive infant, immediately or within 72 hours […] antenatal prophylaxis with anti-D: NICE now recommends that routine anti-D prophylaxis is offered to all non-sensitised pregnant women who are RhD negative […] anti-D has the effect of mopping up any rhesus positive cells from the infant in the maternal circulation, and preventing the mother from mounting an immune response. In this way, future pregnancies are protected […] if additional prophylactic doses of anti-D are given at 28 and 34 weeks then the risk of sensitization is reduced from 1.12% to 0.28%. […] routine anti-D prophylaxis is offered to all non-sensitised pregnant women who are RhD negative. […] if a pregnant woman is RhD-negative, consideration should be given to offering partner testing to determine whether the administration of anti-D prophylaxis is necessary.

• #11

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181__prevention_of_rh_d.54.aspx

  Prevention of Rh D alloimmunization. Practice Bulletin No. 181. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e5770. […] Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization. […] Anti-D immune globulin is extracted by cold alcohol fractionation from plasma donated by individuals with high-titer anti-D immune globulin G antibodies. […] A prophylactic dose of 300 micrograms of anti-D immune globulin can prevent Rh D alloimmunization after exposure to up to 30 mL of Rh D-positive fetal whole blood or 15 mL of fetal red blood cells.

• #12

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181__prevention_of_rh_d.54.aspx

  Prevention of Rh D alloimmunization. Practice Bulletin No. 181. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e5770. […] Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization. […] Anti-D immune globulin is extracted by cold alcohol fractionation from plasma donated by individuals with high-titer anti-D immune globulin G antibodies. […] A prophylactic dose of 300 micrograms of anti-D immune globulin can prevent Rh D alloimmunization after exposure to up to 30 mL of Rh D-positive fetal whole blood or 15 mL of fetal red blood cells.

• #13 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #14 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Introduction of anti-Rh(D) immunoglobulin more than 50 years ago, has only resulted in a 50% decrease of Rhesus (Rh) Disease globally, due to a low uptake of this prophylaxis. […] In 2021 the Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention of Rh Disease by immunoprophylaxis, considering the cost effectiveness of the different dose regimens and prioritizing its administration by indication. […] Practice recommendations: measures to prevent sensitization to Rh(D). […] First priority: Determine the maternal Rh factor, preferably in early pregnancy. […] Give Anti-Rh(D) immunoglobulin within 72 hours after birth to women who have delivered Rh-positive newborns, unless already sensitized. […] Routine Anti-Rh(D) prophylaxis during pregnancy: 1,500 IU (300 g) at 28-34 weeks.

• #15 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  Prophylaxis of alloimmunization by Rh (D) antigen is performed by administration of anti-Rh (D) immunoglobulin [IgRh (D)]. […] Immunoglobulin administration is indicated in the postpartum period of Rh-negative, non-sensitized women (negative indirect Coombs test) whose neonate is Rh-positive. […] Gestational prophylaxis is also indicated for events that increase the risk of fetal-maternal hemorrhage, such as: Abortion; First trimester bleeding; Hydatidiform mole pregnancy; Ectopic pregnancies; Invasive procedures (chorionic villus sampling, amniocentesis, fetal surgery); Stillbirth; Hemorrhages of the second and third trimesters; Abdominal trauma; External version. […] IgRh (D) (300 g) should be administered within 72 hours after delivery, although some efficacy is reported up to 28 days postpartum.

• #16 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  Prophylaxis of alloimmunization by Rh (D) antigen is performed by administration of anti-Rh (D) immunoglobulin [IgRh (D)]. […] Immunoglobulin administration is indicated in the postpartum period of Rh-negative, non-sensitized women (negative indirect Coombs test) whose neonate is Rh-positive. […] Gestational prophylaxis is also indicated for events that increase the risk of fetal-maternal hemorrhage, such as: Abortion; First trimester bleeding; Hydatidiform mole pregnancy; Ectopic pregnancies; Invasive procedures (chorionic villus sampling, amniocentesis, fetal surgery); Stillbirth; Hemorrhages of the second and third trimesters; Abdominal trauma; External version. […] IgRh (D) (300 g) should be administered within 72 hours after delivery, although some efficacy is reported up to 28 days postpartum.

• #17 Rh incompatibility Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/rh-incompatibility

  Rh incompatibility is almost completely preventable. Rh-negative mothers should be followed closely by their providers during pregnancy. […] Special immune globulins, called RhoGAM, are now used to prevent RH incompatibility in mothers who are Rh-negative. […] If the father of the infant is Rh-positive or if his blood type is not known, the mother is given an injection of RhoGAM during the second trimester. […] These injections prevent the development of antibodies against Rh-positive blood. However, women with Rh-negative blood type must get injections: During every pregnancy, After a miscarriage or abortion, After prenatal tests such as amniocentesis and chorionic villus biopsy, After injury to the abdomen during pregnancy.

• #18 Rh disease: causes, risks, symptoms and prevention | WIRhE

  https://wirhe.org/rh-disease/

  It is given once at about 28 weeks of pregnancy (6.5 months), and again shortly after the birth of the baby (within 72 hours). It may also need to be given during pregnancy in case of bleeding, trauma, miscarriage, ectopic pregnancy, abortion, or invasive procedures, like amniocentesis or fetal blood sampling.

• #19

  https://www.nhs.uk/conditions/rhesus-disease/prevention/

  Rhesus disease can largely be prevented by having an injection of a medication called anti-D immunoglobulin. […] Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative. This routine administration of anti-D immunoglobulin is called routine antenatal anti-D prophylaxis, or RAADP (prophylaxis means a step taken to prevent something from happening). […] RAADP is recommended for all pregnant RhD negative women who haven’t been sensitised to the RhD antigen, even if you previously had an injection of anti-D immunoglobulin. […] After giving birth, a sample of your baby’s blood will be taken from the umbilical cord. If you’re RhD negative and your baby is RhD positive, and you haven’t already been sensitised, you’ll be offered an injection of anti-D immunoglobulin within 72 hours of giving birth. This means your blood won’t have a chance to produce antibodies and will significantly decrease the risk of your next baby having rhesus disease. […] However, the evidence in support of RAADP shows that the benefits of preventing sensitisation far outweigh these small risks.

• #20 Anti D Prophylaxis – Saolta Maternity Services

  https://www.uhgmaternity.com/parenting/anti-d-prophylaxis/

  Prophylaxis is the word given to a medicine that is used to prevent something happening. Anti-D prophylaxis means giving anti-D immunoglobulin to prevent a woman producing antibodies against RhD-positive blood cells and so to prevent the development of HDN in an unborn baby. […] Routine antenatal anti-D prophylaxis (RAADP) is given by injection to pregnant women who are RhD negative usually at week 28 of their pregnancy. […] If an RhD negative woman has a potentially sensitising event DURING THE pregnancy she will be offered anti-D prophylaxis at the time of the event: this is known as antenatal anti-D prophylaxis or AADP. […] If you are pregnant and are RhD negative you should be offered RAADP if you have not already been sensitised, this means that you have already have antibodies to the D antigen in your blood that can be detected by a blood test at the beginning of your pregnancy. […] You should be offered RAADP even if you have already had AADP for a potentially sensitising event earlier in your pregnancy. […] Following administration of medications and /or following surgical management you will be offered Anti-D.

• #21 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #22 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Introduction of anti-Rh(D) immunoglobulin more than 50 years ago, has only resulted in a 50% decrease of Rhesus (Rh) Disease globally, due to a low uptake of this prophylaxis. […] In 2021 the Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention of Rh Disease by immunoprophylaxis, considering the cost effectiveness of the different dose regimens and prioritizing its administration by indication. […] Practice recommendations: measures to prevent sensitization to Rh(D). […] First priority: Determine the maternal Rh factor, preferably in early pregnancy. […] Give Anti-Rh(D) immunoglobulin within 72 hours after birth to women who have delivered Rh-positive newborns, unless already sensitized. […] Routine Anti-Rh(D) prophylaxis during pregnancy: 1,500 IU (300 g) at 28-34 weeks.

• #23 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Anti-Rh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational stages), or after spontaneous or medical abortion/miscarriage after 10 weeks of gestation. […] Anti-Rh(D) prophylaxis after bleeding, abdominal trauma in pregnancy and/or fetal death (500 or 1,500 IU; 100 or 300 g), during second or third trimester of pregnancy. […] The risk of fetalmaternal transfusion during external cephalic version ranges from 2 to 6%. […] Therefore, administration of anti-Rh(D) immunoglobulin is advised. […] Non-invasive first-trimester prenatal testing of cell-free DNA may be used to determine fetal Rh(D) status. […] First-trimester non-invasive Rh(D) typing may therefore be used to prevent unnecessary anti-Rh(D) immunoglobulin administration in the course of pregnancy. […] Prophylaxis in the third trimester should optimally consist of a dose of 1,500 IU given once between 28 and 34 weeks.

• #24 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  If the RhD-negative pregnant woman does not receive anti-D IgG prophylaxis after the birth of a RhD-positive infant, the incidence of sensitization during pregnancy will be 12-16%. […] The rate of sensitization when prevention after birth is performed is 1.6-1.9%, while antenatal prophylaxis reduces the rate of sensitization during pregnancy to 0.2%. […] Administration of antenatal immunoglobulin is recommended by most authors. […] In order to prevent spontaneous sensitization during pregnancy, especially in the third trimester, in the US it is recommended the use of 300 g at the 28th gestational week; in the UK, France, Australia, Cuba and Canada the recommended dose is of 100 g of IgRh (D) at 28 and 34 weeks. […] Most protocols recommend that anti-D IgG should be given to non-sensitized Rh-negative women at 28 weeks of gestation when the fetal blood group type is Rh-positive or unknown.

• #25 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  According to the Cochrane reviewers, as a result of antenatal prophylaxis [100 g (500 UI) of anti-D IgG in the 28th to 34th weeks], the risk of alloimmunisation of Rh(D)-negative pregnant women drops from about 1% to 0.2% and the probability of immunisation in subsequent pregnancies is also reduced; the NNT to avoid one case of sensitisation is 213. […] Various international recommendations suggest antenatal anti-D prophylaxis (i.m. or i.v.) in unsensitised Rh(D)-negative women as a complement to post-partum prophylaxis. […] The currently available evidence demonstrates that antenatal anti-D prophylaxis, besides being a cost-effective strategy, is able to further reduce the incidence of sensitisation to D antigen down to about 0.2%; a variety of prophylactic regimens are used in different countries, although 300 g of anti-D IgG in the 28th week is the dose most commonly indicated in international recommendations.

• #26 Anti-D immunoglobulin prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in women : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anti-d-immunoglobulin-prophylaxis-to-optimize-prevention-of-rhesus-rh-alloimmunization-in-women/

  Anti-D immunoglobulin prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in women […] Women who are Rhesus (Rh)-negative and exposed to fetal Rh-positive red cells are at risk for developing Rh alloimmunization putting a future Rh-negative fetus at risk of hemolytic disease of the fetus and newborn (HDFN). […] If anti-D Ig is given appropriately at 28-30 weeks GA and following delivery of an Rh-positive infant, the risk of alloimmunization is reduced to 0.1% from 16%. […] All Rh-negative pregnant women should be offered routine prophylaxis with anti-D immunoglobulin (anti-D Ig), during their third trimester of pregnancy. […] Evidence for benefit of prophylaxis following potentially sensitizing events in early pregnancy is less (particularly early in the first trimester with less fetomaternal blood exposure) but risks of administration are low therefore it is currently recommended.

• #27

  https://www.nhs.uk/conditions/rhesus-disease/prevention/

  Rhesus disease can largely be prevented by having an injection of a medication called anti-D immunoglobulin. […] Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative. This routine administration of anti-D immunoglobulin is called routine antenatal anti-D prophylaxis, or RAADP (prophylaxis means a step taken to prevent something from happening). […] RAADP is recommended for all pregnant RhD negative women who haven’t been sensitised to the RhD antigen, even if you previously had an injection of anti-D immunoglobulin. […] After giving birth, a sample of your baby’s blood will be taken from the umbilical cord. If you’re RhD negative and your baby is RhD positive, and you haven’t already been sensitised, you’ll be offered an injection of anti-D immunoglobulin within 72 hours of giving birth. This means your blood won’t have a chance to produce antibodies and will significantly decrease the risk of your next baby having rhesus disease. […] However, the evidence in support of RAADP shows that the benefits of preventing sensitisation far outweigh these small risks.

• #28 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #29 Rhesus D (RhD) negative blood type: care in pregnancy and after birth | CUH

  https://www.cuh.nhs.uk/patient-information/-guidance-on-the-use-of-routine-antenatal-anti-d-prophylaxis-raadp-and-postnatal-care-for-rhd-negative-women/

  If you are RhD negative and you have a potentially sensitising event (such as an injury to your bump or vaginal bleeding) during any stage of pregnancy, it is recommended that an FMH blood test is taken (depending on how pregnant you are) and you will be offered additional anti-D prophylaxis. This must be within 72 hours of the sensitising event. […] If you are RhD negative, after you have given birth, a blood sample is taken to test your babys blood group and RhD status. This sample is usually taken from the part of the umbilical cord that is attached to the placenta. […] If your babys blood group is found to be RhD positive, you will be offered a further injection of anti-D. This is known as postnatal anti-D prophylaxis. This dose is the same as the antenatal dose 1,500 international units of Rhophylac 300 administered into the upper arm muscle within 72 hours of the birth.

• #30 Hemolytic Disease of the Fetus and Neonate – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/hemolytic-disease-of-the-fetus-and-neonate

  Recommendations vary regarding whether Rho(D) immune globulin is required for spontaneous or induced abortion at 2, 3, 4). For these early pregnancies, some medical societies advise no prophylaxis and others advise prophylaxis only if there was a surgical procedure. […] If the presence of fetomaternal hemorrhage is uncertain, a rosette test (addition of an anti-D reagent to maternal blood) is used as an initial qualitative screening test. If results are positive, a Kleihauer-Betke assay (acid elution) or flow cytometry can measure the volume of fetal blood in the maternal circulation. If test results indicate fetomaternal hemorrhage is massive ( 30 mL whole blood), additional injections (300 mcg for every 30 mL of fetal whole blood, up to 5 doses within 24 hours) are necessary.

• #31

  https://www.nhs.uk/conditions/rhesus-disease/

  Rhesus disease is uncommon these days because it can usually be prevented using injections of a medication called anti-D immunoglobulin. […] If the mother is RhD negative, she’ll be offered injections of anti-D immunoglobulin at certain points in her pregnancy when she may be exposed to the baby’s red blood cells. This anti-D immunoglobulin helps to remove the RhD foetal blood cells before they can cause sensitisation. […] If a woman has developed anti-D antibodies in a previous pregnancy (she’s already sensitised) then these immunoglobulin injections don’t help. The pregnancy will be monitored more closely than usual, as will the baby after delivery.

• #32

  https://www.singhealth.com.sg/patient-care/conditions-treatments/anti-d-immunoglobulin-for-rhesus-d-prophylaxis

  Anti-D immunoglobulin is an intramuscular injection which can prevent a Rhesus-Negative mother from producing antibodies against Rhesus-Positive blood cells. […] Anti-D immunoglobulin is usually administered at around the 28th week of pregnancy to pregnant Rhesus-Negative women who are not already sensitised. […] After childbirth, if your baby is found to be Rhesus-Positive, you will be given another Anti-D immunoglobulin injection, usually within 72 hours of the birth. […] In addition, you are advised to have an Anti-D immunoglobulin injection following a potentially sensitising event, which is when there is a high risk of your blood and the blood of your baby becoming mixed. […] Anti-D immunoglobulin should be given as soon as possible and within 72 hours of a sensitising event.

• #33 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  Prophylaxis of alloimmunization by Rh (D) antigen is performed by administration of anti-Rh (D) immunoglobulin [IgRh (D)]. […] Immunoglobulin administration is indicated in the postpartum period of Rh-negative, non-sensitized women (negative indirect Coombs test) whose neonate is Rh-positive. […] Gestational prophylaxis is also indicated for events that increase the risk of fetal-maternal hemorrhage, such as: Abortion; First trimester bleeding; Hydatidiform mole pregnancy; Ectopic pregnancies; Invasive procedures (chorionic villus sampling, amniocentesis, fetal surgery); Stillbirth; Hemorrhages of the second and third trimesters; Abdominal trauma; External version. […] IgRh (D) (300 g) should be administered within 72 hours after delivery, although some efficacy is reported up to 28 days postpartum.

• #34 Anti-D immunoglobulin prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in women : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anti-d-immunoglobulin-prophylaxis-to-optimize-prevention-of-rhesus-rh-alloimmunization-in-women/

  A single dose of 300 mcg or 1500 IU anti-D Ig at 28 weeks GA. […] Another dose of 1500 IU within 72 hours of delivery of a D-positive newborn. If not given at delivery, anti-D Ig should be given as soon as possible up to 28 days after delivery. […] WinRho Dosing prophylaxis based on gestational age and exposure event: 250 IU (50 mcg) dose is recommended before 12 weeks gestation, although 1500 IU (300 mcg) can be administered if lower doses are not available. […] After 12 weeks, a 1500 IU (300-mcg) dose should be given.

• #35 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  AntiRh(D) prophylaxis after bleeding, abdominal trauma in pregnancy, and/or fetal death (500 or 1500 IU; 100 or 300 g) during the second or third trimester. […] AntiRh(D) immunoglobulin administration is strictly advised for ectopic pregnancy. […] The optimal dose of antiRh(D) immunoglobulin is not known (1500 IU is most commonly used). […] The risk of fetalmaternal transfusion during external cephalic version ranges from 2% to 6%; therefore, administration of antiRh(D) immunoglobulin is advised. […] Noninvasive prenatal testing of cellfree DNA in the first trimester of pregnancy may be used to determine fetal Rh(D) status. […] Box 1 summarizes the measures to prevent antiRh(D) sensitization, taking into account the costeffectiveness of the different dose regimens and prioritizing the administration of antiRh(D) by indication.

• #36 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  AntiRh(D) prophylaxis after bleeding, abdominal trauma in pregnancy, and/or fetal death (500 or 1500 IU; 100 or 300 g) during the second or third trimester. […] AntiRh(D) immunoglobulin administration is strictly advised for ectopic pregnancy. […] The optimal dose of antiRh(D) immunoglobulin is not known (1500 IU is most commonly used). […] The risk of fetalmaternal transfusion during external cephalic version ranges from 2% to 6%; therefore, administration of antiRh(D) immunoglobulin is advised. […] Noninvasive prenatal testing of cellfree DNA in the first trimester of pregnancy may be used to determine fetal Rh(D) status. […] Box 1 summarizes the measures to prevent antiRh(D) sensitization, taking into account the costeffectiveness of the different dose regimens and prioritizing the administration of antiRh(D) by indication.

• #37 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Anti-Rh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational stages), or after spontaneous or medical abortion/miscarriage after 10 weeks of gestation. […] Anti-Rh(D) prophylaxis after bleeding, abdominal trauma in pregnancy and/or fetal death (500 or 1,500 IU; 100 or 300 g), during second or third trimester of pregnancy. […] The risk of fetalmaternal transfusion during external cephalic version ranges from 2 to 6%. […] Therefore, administration of anti-Rh(D) immunoglobulin is advised. […] Non-invasive first-trimester prenatal testing of cell-free DNA may be used to determine fetal Rh(D) status. […] First-trimester non-invasive Rh(D) typing may therefore be used to prevent unnecessary anti-Rh(D) immunoglobulin administration in the course of pregnancy. […] Prophylaxis in the third trimester should optimally consist of a dose of 1,500 IU given once between 28 and 34 weeks.

• #38 Anti-D (Rho) immunoglobulin

  https://patient.info/doctor/anti-d-rho-immunoglobulin

  All RhD-negative pregnant women who do not have immune anti-D, should be offered additional routine prophylaxis with anti-D immunoglobulin (anti-D Ig) during the third trimester of pregnancy. […] Following potentially sensitising events, it is recommended that anti-D immunoglobulin should be administered as soon as possible and always within 72 hours of the event. […] For potentially sensitising events between 12 and 20 weeks of gestation, a dose of 250 IU should be administered within 72 hours of the event. […] For potentially sensitising events between 20 weeks of gestation and term, a dose of 500 IU should be administered within 72 hours of the event. […] Routine antenatal anti-D prophylaxis (RAADP) programme Routine prophylaxis is separate from that given after potentially sensitising events, as above, or threats to the pregnancy. […] After a Kleihauer test, at least 500 IU of anti-D should be given to every non-sensitised RhD-negative woman, within 72 hours of delivering a rhesus-positive infant.

• #39

  https://www.singhealth.com.sg/patient-care/conditions-treatments/anti-d-immunoglobulin-for-rhesus-d-prophylaxis

  Anti-D immunoglobulin is an intramuscular injection which can prevent a Rhesus-Negative mother from producing antibodies against Rhesus-Positive blood cells. […] Anti-D immunoglobulin is usually administered at around the 28th week of pregnancy to pregnant Rhesus-Negative women who are not already sensitised. […] After childbirth, if your baby is found to be Rhesus-Positive, you will be given another Anti-D immunoglobulin injection, usually within 72 hours of the birth. […] In addition, you are advised to have an Anti-D immunoglobulin injection following a potentially sensitising event, which is when there is a high risk of your blood and the blood of your baby becoming mixed. […] Anti-D immunoglobulin should be given as soon as possible and within 72 hours of a sensitising event.

• #40 RhIG Prophylaxis

  https://www.labce.com/spg414916_rhig_prophylaxis.aspx?srsltid=AfmBOopOetVjPXD4UoXowQmk5_rduDWiDFe7LCiNwXVfl00k-wDMhISq

  One of the main purposes of perinatal testing programs is to determine which women are candidates for RhIG. If given soon enough following exposure to D+ red cells, and in a suitable dosage, RhIG has the ability to prevent immunization to D. RhIG should be administered within 72 hours of any event that would be associated with a risk for FMH, such as amniocentesis or delivery; however, RhIG should not be withheld if this time limit has been exceeded. These dosages are recommended: […] Administration of both an antepartum and postpartum dose of RhIG has significantly reduced the risk for the production of anti-D in Rh-negative women who deliver Rh-positive babies. The current rate of RhIG „failure” is approximately 0.1%.

• #41

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181_summary__prevention_of.48.aspx

  Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 13-16% to approximately 0.5-1.8%. […] Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery. […] Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive.

• #42 Prevention of Rh D Alloimmunization | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/08/prevention-of-rh-d-alloimmunization

  ABSTRACT: Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 1316% to approximately 0.51.8%. The risk was further reduced to 0.140.2% with the addition of routine antepartum administration. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization.

• #43 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  According to the Cochrane reviewers, as a result of antenatal prophylaxis [100 g (500 UI) of anti-D IgG in the 28th to 34th weeks], the risk of alloimmunisation of Rh(D)-negative pregnant women drops from about 1% to 0.2% and the probability of immunisation in subsequent pregnancies is also reduced; the NNT to avoid one case of sensitisation is 213. […] Various international recommendations suggest antenatal anti-D prophylaxis (i.m. or i.v.) in unsensitised Rh(D)-negative women as a complement to post-partum prophylaxis. […] The currently available evidence demonstrates that antenatal anti-D prophylaxis, besides being a cost-effective strategy, is able to further reduce the incidence of sensitisation to D antigen down to about 0.2%; a variety of prophylactic regimens are used in different countries, although 300 g of anti-D IgG in the 28th week is the dose most commonly indicated in international recommendations.

• #44 Use of Anti-D immunoglobulin for the Prevention of Haemolytic Disease of the Fetus and Newborn

  https://b-s-h.org.uk/guidelines/guidelines/use-of-anti-d-immunoglobulin-for-the-prevention-of-haemolytic-disease-of-the-fetus-and-newborn

  The objective of this guideline is to provide healthcare professionals with practical guidance on the use of anti-D Ig as immunoprophylaxis to prevent sensitisation to the D antigen during pregnancy or at delivery for the prevention of HDN. […] Following routine post-partum administration of anti-D Ig, the rate of alloimmunisation dropped to approximately 2%. A further reduction in the sensitisation rate ranging from 017 to 028% was achieved by introducing routine antenatal prophylaxis during the third trimester of pregnancy. […] These findings contributed to the National Institute for Clinical Excellence (NICE) recommendation that all D negative pregnant women who do not have immune anti-D, should be offered additional routine prophylaxis with anti-D Ig during the third trimester of pregnancy.

• #45 Anti-D immunoglobulin prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in women : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/anti-d-immunoglobulin-prophylaxis-to-optimize-prevention-of-rhesus-rh-alloimmunization-in-women/

  Anti-D immunoglobulin prophylaxis to optimize prevention of rhesus (Rh) alloimmunization in women […] Women who are Rhesus (Rh)-negative and exposed to fetal Rh-positive red cells are at risk for developing Rh alloimmunization putting a future Rh-negative fetus at risk of hemolytic disease of the fetus and newborn (HDFN). […] If anti-D Ig is given appropriately at 28-30 weeks GA and following delivery of an Rh-positive infant, the risk of alloimmunization is reduced to 0.1% from 16%. […] All Rh-negative pregnant women should be offered routine prophylaxis with anti-D immunoglobulin (anti-D Ig), during their third trimester of pregnancy. […] Evidence for benefit of prophylaxis following potentially sensitizing events in early pregnancy is less (particularly early in the first trimester with less fetomaternal blood exposure) but risks of administration are low therefore it is currently recommended.

• #46 Prevention of Rhesus Alloimmunization | Article | GLOWM

  https://www.glowm.com/article/heading/vol-3–elements-of-professional-care-and-support-before-during-and-after-pregnancy–prevention-of-rhesus-alloimmunization/id/412153

  If the RhD-negative pregnant woman does not receive anti-D IgG prophylaxis after the birth of a RhD-positive infant, the incidence of sensitization during pregnancy will be 12-16%. […] The rate of sensitization when prevention after birth is performed is 1.6-1.9%, while antenatal prophylaxis reduces the rate of sensitization during pregnancy to 0.2%. […] Administration of antenatal immunoglobulin is recommended by most authors. […] In order to prevent spontaneous sensitization during pregnancy, especially in the third trimester, in the US it is recommended the use of 300 g at the 28th gestational week; in the UK, France, Australia, Cuba and Canada the recommended dose is of 100 g of IgRh (D) at 28 and 34 weeks. […] Most protocols recommend that anti-D IgG should be given to non-sensitized Rh-negative women at 28 weeks of gestation when the fetal blood group type is Rh-positive or unknown.

• #47

  https://www.nhs.uk/conditions/rhesus-disease/

  Rhesus disease is uncommon these days because it can usually be prevented using injections of a medication called anti-D immunoglobulin. […] If the mother is RhD negative, she’ll be offered injections of anti-D immunoglobulin at certain points in her pregnancy when she may be exposed to the baby’s red blood cells. This anti-D immunoglobulin helps to remove the RhD foetal blood cells before they can cause sensitisation. […] If a woman has developed anti-D antibodies in a previous pregnancy (she’s already sensitised) then these immunoglobulin injections don’t help. The pregnancy will be monitored more closely than usual, as will the baby after delivery.

• #48 Rh disease: causes, risks, symptoms and prevention | WIRhE

  https://wirhe.org/rh-disease/

  If a mother is known to be at risk for Rh disease, a health care provider can use a prescription medication called anti-D (Rh) immunoglobulin. This injection is typically given twice during the pregnancy to prevent the mother’s immune system from attacking the child’s blood cells. One injection is typically at the 28-week mark of pregnancy and the other is shortly after the child’s birth. It may be given earlier in pregnancy or more than twice if there are any extra risk factors. This medication is very well tolerated. […] However, this medication only works if the mother has not yet become sensitized to the Rh factor. […] Treatment mainly focuses on prevention. If a mother is at risk, then a drug called Rh immunoglobulin will be used. It is a shot, typically given twice during pregnancy, which can help prevent harm to the baby. However, it only works if the mother’s body has not already begun attacking the child’s blood cells.

• #49 Rhesus Incompatibility – Zero To Finals

  https://zerotofinals.com/obgyn/antenatal/rhesus/

  Women that are rhesus-D positive do not need any additional treatment during pregnancy. […] Prevention of sensitisation is the mainstay of management. This involves giving intramuscular anti-D injections to rhesus-D negative women. There is no way to reverse the sensitisation process once it has occurred, which is why prophylaxis is so essential. […] The anti-D medication works by attaching itself to the rhesus-D antigens on the fetal red blood cells in the mothers circulation, causing them to be destroyed. This prevents the mother’s immune system recognising the antigen and creating its own antibodies to the antigen. It acts as a prevention for the mother becoming sensitised to the rhesus-D antigen. […] Anti-D injections are given routinely on two occasions: 28 weeks gestation and Birth (if the baby’s blood group is found to be rhesus-positive).

• #50 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #51 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Anti-Rh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational stages), or after spontaneous or medical abortion/miscarriage after 10 weeks of gestation. […] Anti-Rh(D) prophylaxis after bleeding, abdominal trauma in pregnancy and/or fetal death (500 or 1,500 IU; 100 or 300 g), during second or third trimester of pregnancy. […] The risk of fetalmaternal transfusion during external cephalic version ranges from 2 to 6%. […] Therefore, administration of anti-Rh(D) immunoglobulin is advised. […] Non-invasive first-trimester prenatal testing of cell-free DNA may be used to determine fetal Rh(D) status. […] First-trimester non-invasive Rh(D) typing may therefore be used to prevent unnecessary anti-Rh(D) immunoglobulin administration in the course of pregnancy. […] Prophylaxis in the third trimester should optimally consist of a dose of 1,500 IU given once between 28 and 34 weeks.

• #52 Cenata GmbH Rhesus prophylaxis – Cenata GmbH

  https://www.cenata.de/en/rh-prophylaxis/

  Because anti-D can cause haemolytic disease* in the fetus, rhesus prophylaxis was introduced at the end of the 1960s. In this treatment, a small dose of anti-D, such as Rhophylac 300, is administered to the mother. This breaks down any of the fetus erythrocytes that may enter the mothers blood stream, thus preventing the mother from being immunized against the fetus RhD factor. At birth, a newborns blood group is determined from the umbilical cord blood. If the newborn is RhD-positive, Rh prophylaxis is administered to an RhD-negative mother. […] According to maternal care guidelines in the past, Rh prophylaxis has been administered to all RhD-negative pregnant women in the 28th 30th week of pregnancy, independent of the rhesus status of the unborn child. Rh prophylaxis is therefore administered to some pregnant women without actually being medically necessary. This affects around 40% of RhD-negative pregnant women.

• #53 Haemolytic disease of the fetus and newborn (HDFN) | Lifeblood

  https://www.lifeblood.com.au/health-professionals/clinical-practice/clinical-indications/HDFN

  The rate of RhD antibody formation can be reduced to 0.2% or less by the administration of RhD immunoglobulin during pregnancy, at 28 weeks and 34 weeks (antenatal prophylaxis), as well as after the birth of a RhD positive baby and for sensitising events. […] Routine RhD immunoglobulin prophylaxis is recommended for all RhD negative pregnant women with no preformed RhD antibodies, unless NIPT for fetal RhD has predicted they are not carrying a RhD positive fetus. […] Routine RhD immunoglobulin prophylaxis is recommended for all RhD negative women with no preformed RhD antibodies who have a baby who is predicted to be RhD positive based on NIPT for fetal RHD, or cord blood or neonatal RhD typing. […] RhD immunoglobulin should be administered as soon as possible following birth, ideally within 72 hours for most effective prophylaxis.

• #54 Where does the Rho(D) immune globulin (anti-D) Come From? | International Confederation of Midwives

  https://internationalmidwives.org/where-does-the-rhod-immune-globulin-anti-d-come-from/

  It wasn’t until the mid-1960s that a preventative treatment was discovered. […] The anti-D antibody was harvested from the plasma of Rh-negative prisoners who had been sensitised with positive blood. These antibodies were then injected into unsensitised prisoners affording them complete protection from sensitisation when exposed to positive blood. […] The NIPA test is a maternal blood test in pregnancy which identifies fractionated foetal DNA and the foetal blood type with the aim of reducing anti-D usage in the context of a global shortage of donors. […] Of all the life-altering medical discoveries made during the 20th century, the discovery of rhesus factor and subsequent anti-D treatment is one that has had immeasurable impact on perinatal outcomes.

• #55 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  The enormous lack of prevention identified in the current study should be regarded as a global emergency due to a lack of maternal accessibility to IgG anti-Rh(D). As such, cooperation between health authorities, the pharmaceutical industry, and the relevant healthcare providers (e.g., physicians, nurses, midwives) is urgently needed to monitor the ongoing status of this worldwide gap and to guarantee access to, at least, post-partum immunoprophylaxis for all Rh(D)-negative women who deliver an Rh(D)-positive baby.

• #56 RhD alloimmunization: Prevention in pregnant and postpartum patients – UpToDate

  https://www.uptodate.com/contents/rhd-alloimmunization-prevention-in-pregnant-and-postpartum-patients

  RhD alloimmunization: Prevention in pregnant and postpartum patients […] Widespread use of anti-D immune globulin (Rho(D) immune globulin) during pregnancy and postpartum has dramatically reduced, but not eliminated, D alloimmunization caused by fetal RBCs that have gained access to the maternal circulation. […] Use of anti-D immune globulin for prevention of RhD alloimmunization will be discussed here. […] Standard prophylaxis at 28 or 28 plus 34 weeks of gestation […] Administration of anti-D immune globulin […] Prophylaxis for pregnancy complications […] Administration of anti-D immune globulin […] Prophylaxis after delivery […] Postpartum dosing […] Testing for fetomaternal bleeding […] Dosing for large fetomaternal hemorrhages.

• #57 Hemolytic Disease of the Fetus and Neonate – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/hemolytic-disease-of-the-fetus-and-neonate

  Recommendations vary regarding whether Rho(D) immune globulin is required for spontaneous or induced abortion at 2, 3, 4). For these early pregnancies, some medical societies advise no prophylaxis and others advise prophylaxis only if there was a surgical procedure. […] If the presence of fetomaternal hemorrhage is uncertain, a rosette test (addition of an anti-D reagent to maternal blood) is used as an initial qualitative screening test. If results are positive, a Kleihauer-Betke assay (acid elution) or flow cytometry can measure the volume of fetal blood in the maternal circulation. If test results indicate fetomaternal hemorrhage is massive ( 30 mL whole blood), additional injections (300 mcg for every 30 mL of fetal whole blood, up to 5 doses within 24 hours) are necessary.

• #58 Hemolytic Disease of the Fetus and Neonate – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/hemolytic-disease-of-the-fetus-and-neonate

  Recommendations vary regarding whether Rho(D) immune globulin is required for spontaneous or induced abortion at 2, 3, 4). For these early pregnancies, some medical societies advise no prophylaxis and others advise prophylaxis only if there was a surgical procedure. […] If the presence of fetomaternal hemorrhage is uncertain, a rosette test (addition of an anti-D reagent to maternal blood) is used as an initial qualitative screening test. If results are positive, a Kleihauer-Betke assay (acid elution) or flow cytometry can measure the volume of fetal blood in the maternal circulation. If test results indicate fetomaternal hemorrhage is massive ( 30 mL whole blood), additional injections (300 mcg for every 30 mL of fetal whole blood, up to 5 doses within 24 hours) are necessary.

• #59 Rhesus Incompatibility – Zero To Finals

  https://zerotofinals.com/obgyn/antenatal/rhesus/

  Anti-D injections should also be given at any time where sensitisation may occur, such as: Antepartum haemorrhage, Amniocentesis procedures, Abdominal trauma. […] Anti-D is given within 72 hours of a sensitisation event. After 20 weeks gestation, the Kleinhauer test is performed to see how much fetal blood has passed into the mother’s blood, to determine whether further doses of anti-D are required.

• #60 Hemolytic Disease of the Fetus and Neonate – Gynecology and Obstetrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/hemolytic-disease-of-the-fetus-and-neonate

  Recommendations vary regarding whether Rho(D) immune globulin is required for spontaneous or induced abortion at 2, 3, 4). For these early pregnancies, some medical societies advise no prophylaxis and others advise prophylaxis only if there was a surgical procedure. […] If the presence of fetomaternal hemorrhage is uncertain, a rosette test (addition of an anti-D reagent to maternal blood) is used as an initial qualitative screening test. If results are positive, a Kleihauer-Betke assay (acid elution) or flow cytometry can measure the volume of fetal blood in the maternal circulation. If test results indicate fetomaternal hemorrhage is massive ( 30 mL whole blood), additional injections (300 mcg for every 30 mL of fetal whole blood, up to 5 doses within 24 hours) are necessary.

• #61 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #62 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #63 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., Rh disease), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). […] Therefore, most current guidelines, prepared by various associations of healthcare professionals involved in preventing and managing HDFN, including obstetricians and gynecologists, pediatricians and neonatologists, hematologists, and specialists in transfusion medicine, recommend that immunoprophylaxis with IgG anti-Rh(D) be given to every non-sensitized Rh(D)-negative woman, as follows: (1) at 28 weeks of gestation during each pregnancy, (2) immediately after delivery of every Rh(D)-positive neonate, and (3) in the context of any other event that could expose her to the Rh(D) antigen (e.g., abortion, miscarriage, abdominal trauma)

• #64 Appropriate provision of anti-D prophylaxis to RhD negative pregnant women: a scoping review | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-014-0411-1

  The existing evidence indicates an opportunity for quality improvement in situations where potential sensitizing events are not at routine times in pregnancy, such as miscarriage or fetal demise early in pregnancy. […] The studies included in this review found favourable results in this regard. The routine provision of postnatal anti-D immunoglobulin was fairly consistent across the studies. Studies found that RhD negative women that delivered an RhD positive infant were given anti-D immunoglobulin between 95-100% of the time. […] This review found that the provision of anti-D immunoglobulin was low in situations for which potential sensitizing events occur. […] The existing research provides the evidence that anti-D is not always given at the right time or at all; although, in controlled environments such as maternity wards RhD negative women are receiving prophylaxis post-delivery almost 100% of the time. […] There is a need for an increased efficiency with the provision of anti-D immunoglobulin, particularly in situations of potential sensitizing events.

• #65 Rh disease – Wikipedia

  https://en.wikipedia.org/wiki/Rh_disease

  In Arar, Saudi Arabia, results of a study showed that women had a low level of knowledge regarding maternalfetal blood incompatibility (about 38% of the studied mothers during the research had knowledge about Rh incompatibility). Regarding their knowledge about anti-D, researchers found that 68.5% of the mothers had knowledge about it, while only 51% of the mothers had knowledge about the administration of prophylactic anti D after delivery.

• #66 Rh disease – Wikipedia

  https://en.wikipedia.org/wiki/Rh_disease

  In Arar, Saudi Arabia, results of a study showed that women had a low level of knowledge regarding maternalfetal blood incompatibility (about 38% of the studied mothers during the research had knowledge about Rh incompatibility). Regarding their knowledge about anti-D, researchers found that 68.5% of the mothers had knowledge about it, while only 51% of the mothers had knowledge about the administration of prophylactic anti D after delivery.

• #67 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  The annual number of doses of IgG anti-Rh(D) required to provide antenatal and post-partum immunoprophylaxis by GBD Super Region is shown in Table 1, together with the total number of annual doses actually administered and the difference between the number of IgG anti-Rh(D) doses required for post-partum immunoprophylaxis and the number actually administered (i.e., ). Focusing on these worldwide estimates, a total of ~13 million annual doses are required globally to prevent sensitization to Rh(D) (i.e., by providing immunoprophylaxis both antenatally and post-partum). However, fewer than 4 million doses are currently administered annually; this outcome does not even achieve the minimum threshold for preventing Rh(D) sensitization by providing only post-partum immunoprophylaxis, which would require more than 5 million doses annually.

• #68 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #69 Cenata GmbH Rhesus prophylaxis – Cenata GmbH

  https://www.cenata.de/en/rh-prophylaxis/

  The Rh prophylaxis treatment is very safe. Even so, pregnant women occasionally express concern since Rh prophylaxis is a blood product. It is produced from the blood of donors who have previously immunized themselves against the Rhesus-D factor. Although anti-D immunoglobin is an exceptionally infection-proof blood product, transmission of infection cannot be ruled out for all batches and for all pathogens. Human anti-D immunoglobin can also rarely (frequency between 1:1000 and 1:10,000) cause hypersensitivity reactions1. […] It is important to discover if the mother will form anti-D and other blood group antibodies during pregnancy. Two antibody screening tests are therefore usually carried out during pregnancy, one in early pregnancy and another between the 24th and 27th weeks of pregnancy. Other, mostly harmless antibodies will also give a positive test in addition to anti-D, so the vast majority of pregnancies proceed normally even if the antibody test is positive.

• #70 Cenata GmbH Rhesus prophylaxis – Cenata GmbH

  https://www.cenata.de/en/rh-prophylaxis/

  The Rh prophylaxis treatment is very safe. Even so, pregnant women occasionally express concern since Rh prophylaxis is a blood product. It is produced from the blood of donors who have previously immunized themselves against the Rhesus-D factor. Although anti-D immunoglobin is an exceptionally infection-proof blood product, transmission of infection cannot be ruled out for all batches and for all pathogens. Human anti-D immunoglobin can also rarely (frequency between 1:1000 and 1:10,000) cause hypersensitivity reactions1. […] It is important to discover if the mother will form anti-D and other blood group antibodies during pregnancy. Two antibody screening tests are therefore usually carried out during pregnancy, one in early pregnancy and another between the 24th and 27th weeks of pregnancy. Other, mostly harmless antibodies will also give a positive test in addition to anti-D, so the vast majority of pregnancies proceed normally even if the antibody test is positive.

• #71

  https://www.nhs.uk/conditions/rhesus-disease/prevention/

  Rhesus disease can largely be prevented by having an injection of a medication called anti-D immunoglobulin. […] Anti-D immunoglobulin is also administered routinely during the third trimester of your pregnancy if your blood type is RhD negative. This routine administration of anti-D immunoglobulin is called routine antenatal anti-D prophylaxis, or RAADP (prophylaxis means a step taken to prevent something from happening). […] RAADP is recommended for all pregnant RhD negative women who haven’t been sensitised to the RhD antigen, even if you previously had an injection of anti-D immunoglobulin. […] After giving birth, a sample of your baby’s blood will be taken from the umbilical cord. If you’re RhD negative and your baby is RhD positive, and you haven’t already been sensitised, you’ll be offered an injection of anti-D immunoglobulin within 72 hours of giving birth. This means your blood won’t have a chance to produce antibodies and will significantly decrease the risk of your next baby having rhesus disease. […] However, the evidence in support of RAADP shows that the benefits of preventing sensitisation far outweigh these small risks.

• #72 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  Antenatal prophylaxis with anti-D IgG does not have side effects on the foetus and can be considered complementary to post-partum prophylaxis, but the decision on whether to undertake a programme of prophylaxis during pregnancy can be influenced by the commercial availability of anti-D IgG. […] The economic analysis carried out in the United Kingdom demonstrated that the cost per year of life gained from using antenatal anti-D prophylaxis for women in their first pregnancy was low compared to that of other interventions normally offered by the health care service in that country; the same prophylaxis, given to all pregnant women, although costing more, maintained a relatively low cost per year of life gained, thus confirming that antenatal anti-D prophylaxis is a decidedly cost-effective strategy.

• #73 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Hemolytic Disease is often fatal for the fetus or newborn and can cause late miscarriage, stillbirth, early post-natal death and life-long disabilities in surviving babies. […] Fifty years ago, the discovery of Anti-D Immunoglobulins was a medical breakthrough that resulted in a dramatic reduction in the incidence of HDFN in many parts of the world. […] The prenatal protocol with Anti-D Immunoglobulins, introduced in the 1970s in the USA and Western European countries, prescribes screening for all pregnant women and possible administration of treatment. These two steps have led to an almost eradication of HDFN in these countries and in many others. In particular, it has resulted in a dramatic reduction in the number of serious cases that triggered stillbirths or contributed to increased infant mortality and morbidity.

• #74 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #75 Consortium for Universal Rh disease Elimination (CURhE) | Division of Neonatal and Developmental Medicine | Stanford Medicine

  https://med.stanford.edu/content/sm/neonatology/Research/POTR/consortium-for-universal-rh-disease-elimination–curhe-.html

  Every year hundreds of thousands of babies, especially across Africa and Asia, are injured or die of Rh disease because their mothers were not given one or two simple injections just before or after giving birth. […] Rh disease has been virtually eliminated in wealthier nations, thanks to a simple and inexpensive prophylactic immunization developed almost fifty years ago. […] Global implementation of well-documented prevention methods of Rh disease in order to reduce childhood neurological burden and perinatal deaths. […] For every Rh-negative woman to have unfettered prenatal access to counseling and prophylaxis. […] The knowledge, talent and resources of this coalition will allow accurate identification of the Rh disease problem in various countries, effective collaboration with local government and health officials, creative awareness campaigns, and affordable delivery of the needed prophylactic treatment.

• #76 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #77 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Introduction of anti-Rh(D) immunoglobulin more than 50 years ago, has only resulted in a 50% decrease of Rhesus (Rh) Disease globally, due to a low uptake of this prophylaxis. […] In 2021 the Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention of Rh Disease by immunoprophylaxis, considering the cost effectiveness of the different dose regimens and prioritizing its administration by indication. […] Practice recommendations: measures to prevent sensitization to Rh(D). […] First priority: Determine the maternal Rh factor, preferably in early pregnancy. […] Give Anti-Rh(D) immunoglobulin within 72 hours after birth to women who have delivered Rh-positive newborns, unless already sensitized. […] Routine Anti-Rh(D) prophylaxis during pregnancy: 1,500 IU (300 g) at 28-34 weeks.

• #78 Consortium for Universal Rh disease Elimination (CURhE) | Division of Neonatal and Developmental Medicine | Stanford Medicine

  https://med.stanford.edu/content/sm/neonatology/Research/POTR/consortium-for-universal-rh-disease-elimination–curhe-.html

  Every year hundreds of thousands of babies, especially across Africa and Asia, are injured or die of Rh disease because their mothers were not given one or two simple injections just before or after giving birth. […] Rh disease has been virtually eliminated in wealthier nations, thanks to a simple and inexpensive prophylactic immunization developed almost fifty years ago. […] Global implementation of well-documented prevention methods of Rh disease in order to reduce childhood neurological burden and perinatal deaths. […] For every Rh-negative woman to have unfettered prenatal access to counseling and prophylaxis. […] The knowledge, talent and resources of this coalition will allow accurate identification of the Rh disease problem in various countries, effective collaboration with local government and health officials, creative awareness campaigns, and affordable delivery of the needed prophylactic treatment.

• #79 Strengthening Rhesus Disease Prevention in Africa – Eldon Biologicals A/S

  https://eldoncard.com/strengthening-rhesus-disease-prevention-in-africa/

  Globally, there are many areas, including areas in Africa, where there are still no systematic efforts to prevent Rhesus disease. […] The meeting was arranged jointly by WIRhE, AFOG, SRMGO, and SAGO. Eldon Biologicals participated in the meeting continuing its concerted support to the global efforts to eradicate Rhesus disease. […] For more on Rhesus disease and the global Call to Action, see: FIGO/ICM guidelines for preventing Rhesus disease: A call to action Visser 2021 International Journal of Gynecology amp; Obstetrics Wiley Online Library.

• #80 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #81 Prevention of Rhesus (Rh) disease of newborns in Pakistan | The Morris Lab | SickKids | The Morris Lab

  https://lab.research.sickkids.ca/morris/ongoing-research/prevention-of-rhesus-rh-disease-of-newborns-in-pakistan/

  Rhesus (Rh) hemolytic disease is a preventable disease of the newborn that is caused by an incompatibility between maternal and fetal red blood cells. […] The first step towards preventing Rh disease of the newborn is the early identification and prophylactic treatment of Rh(D)-negative women with two doses of anti-D immunoprophylaxis (RhIg). […] The availability of easy-to-use, portable, and affordable technologies can bring Rh testing to rural hard-to-reach communities in LMICs. […] The following characteristics of feasibility were explored: acceptance of the point-of-care test by pregnant women; the ability of lady health visitors to administer the point-of-care test and interpret the results; administration of RhIg prophylaxis by lady health visitors; and acceptability of RhIg by pregnant women.

• #82 EU funding supports critical Rhesus disease prevention project in Kenya – Eldon Biologicals A/S

  https://eldoncard.com/eu-funding-supports-critical-rhesus-disease-prevention-project-in-kenya/

  Eldon Biologicals has received EU funding for a critical project in Kenya. The project will demonstrate how the EldonCard can play a key role in a consolidated effort to prevent Rhesus disease in Africa. […] The project will demonstrate that the EldonCard, when used in a new and innovative organizational setup, constitutes an effective tool in Rhesus disease prevention in low resource settings. The project will document the feasibility of using the EldonCard to identify Rhesus negative mothers and refer them to prophylactic treatment preventing Rhesus disease. […] The project will add blood type testing to the standard tests offered to pregnant women receiving prenatal care at the project sites. Women, who are Rhesus negative, will be offered prophylactic treatment as per existing treatment protocols.

• #83 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  Antenatal prophylaxis with anti-D IgG does not have side effects on the foetus and can be considered complementary to post-partum prophylaxis, but the decision on whether to undertake a programme of prophylaxis during pregnancy can be influenced by the commercial availability of anti-D IgG. […] The economic analysis carried out in the United Kingdom demonstrated that the cost per year of life gained from using antenatal anti-D prophylaxis for women in their first pregnancy was low compared to that of other interventions normally offered by the health care service in that country; the same prophylaxis, given to all pregnant women, although costing more, maintained a relatively low cost per year of life gained, thus confirming that antenatal anti-D prophylaxis is a decidedly cost-effective strategy.

• #84 The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2809506/

  Antenatal prophylaxis with anti-D IgG does not have side effects on the foetus and can be considered complementary to post-partum prophylaxis, but the decision on whether to undertake a programme of prophylaxis during pregnancy can be influenced by the commercial availability of anti-D IgG. […] The economic analysis carried out in the United Kingdom demonstrated that the cost per year of life gained from using antenatal anti-D prophylaxis for women in their first pregnancy was low compared to that of other interventions normally offered by the health care service in that country; the same prophylaxis, given to all pregnant women, although costing more, maintained a relatively low cost per year of life gained, thus confirming that antenatal anti-D prophylaxis is a decidedly cost-effective strategy.

• #85 A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus-negative – White Rose Research Online

  https://eprints.whiterose.ac.uk/id/eprint/1773/

  Prophylactic anti-D, whether antenatal or postpartum, can only suppress primary RhD immunisation; it has no effect in women who have already developed anti-D, however weak. […] The proposed service evaluated in this report is the routine offering of AADP either to all pregnant women who are RhD-negative or to RhD-negative primigravidae only. […] The overall aim of the report was to evaluate the clinical effectiveness of AADP for pregnant women who are RhD-negative, and the comparative cost-effectiveness of: offering routine AADP to all pregnant women who are RhD-negative, offering routine AADP only to primigravidae who are RhD-negative, not offering routine AADP. […] The evidence suggests that routine AADP is effective in reducing the number of RhD-negative pregnant women who are sensitised during pregnancy.

• #86 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #87 Guidelines for Rhesus Disease Prevention | Article | GLOWM

  https://www.glowm.com/article/heading/vol-16–the-prevention-and-management-of-rh-disease–guidelines-for-rhesus-disease-prevention/id/418863

  Introduction of anti-Rh(D) immunoglobulin more than 50 years ago, has only resulted in a 50% decrease of Rhesus (Rh) Disease globally, due to a low uptake of this prophylaxis. […] In 2021 the Federation of Gynecology and Obstetrics (FIGO) has published guidelines on the prevention of Rh Disease by immunoprophylaxis, considering the cost effectiveness of the different dose regimens and prioritizing its administration by indication. […] Practice recommendations: measures to prevent sensitization to Rh(D). […] First priority: Determine the maternal Rh factor, preferably in early pregnancy. […] Give Anti-Rh(D) immunoglobulin within 72 hours after birth to women who have delivered Rh-positive newborns, unless already sensitized. […] Routine Anti-Rh(D) prophylaxis during pregnancy: 1,500 IU (300 g) at 28-34 weeks.

• #88

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181_summary__prevention_of.48.aspx

  Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 13-16% to approximately 0.5-1.8%. […] Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery. […] Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive.

• #89

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181__prevention_of_rh_d.54.aspx

  Prevention of Rh D alloimmunization. Practice Bulletin No. 181. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e5770. […] Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization. […] Anti-D immune globulin is extracted by cold alcohol fractionation from plasma donated by individuals with high-titer anti-D immune globulin G antibodies. […] A prophylactic dose of 300 micrograms of anti-D immune globulin can prevent Rh D alloimmunization after exposure to up to 30 mL of Rh D-positive fetal whole blood or 15 mL of fetal red blood cells.

• #90 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., Rh disease), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). […] Therefore, most current guidelines, prepared by various associations of healthcare professionals involved in preventing and managing HDFN, including obstetricians and gynecologists, pediatricians and neonatologists, hematologists, and specialists in transfusion medicine, recommend that immunoprophylaxis with IgG anti-Rh(D) be given to every non-sensitized Rh(D)-negative woman, as follows: (1) at 28 weeks of gestation during each pregnancy, (2) immediately after delivery of every Rh(D)-positive neonate, and (3) in the context of any other event that could expose her to the Rh(D) antigen (e.g., abortion, miscarriage, abdominal trauma)

• #91 A review of the clinical effectiveness and cost-effectiveness of routine anti-D prophylaxis for pregnant women who are rhesus-negative – White Rose Research Online

  https://eprints.whiterose.ac.uk/id/eprint/1773/

  If a programme of routine AADP were to be adopted, watertight mechanisms would need to be developed to ensure that prophylaxis is offered at the appropriate time to all women at risk of sensitisation, in order to avoid additional cases of sensitisation attributable to failure to provide prophylaxis when appropriate.

• #92 Prevention of Rh D Alloimmunization | ACOG

  https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/08/prevention-of-rh-d-alloimmunization

  ABSTRACT: Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 1316% to approximately 0.51.8%. The risk was further reduced to 0.140.2% with the addition of routine antepartum administration. […] The purpose of this document is to provide evidence-based guidance for the management of patients at risk of Rh D alloimmunization.

• #93

  https://journals.lww.com/greenjournal/fulltext/2017/08000/practice_bulletin_no__181_summary__prevention_of.48.aspx

  Advances in the prevention and treatment of Rh D alloimmunization have been one of the great success stories of modern obstetrics. […] The routine use of Rh D immune globulin is responsible for the reduced rate of red cell alloimmunization in more economically developed countries. First introduced in the 1970s, the postpartum administration of Rh D immune globulin reduced the rate of alloimmunization in at-risk pregnancies from approximately 13-16% to approximately 0.5-1.8%. […] Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery. […] Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive.

• #94 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #95 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  In the mid-20th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., Rh disease), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is ~99% effective at preventing maternal sensitization to Rh(D). […] Therefore, most current guidelines, prepared by various associations of healthcare professionals involved in preventing and managing HDFN, including obstetricians and gynecologists, pediatricians and neonatologists, hematologists, and specialists in transfusion medicine, recommend that immunoprophylaxis with IgG anti-Rh(D) be given to every non-sensitized Rh(D)-negative woman, as follows: (1) at 28 weeks of gestation during each pregnancy, (2) immediately after delivery of every Rh(D)-positive neonate, and (3) in the context of any other event that could expose her to the Rh(D) antigen (e.g., abortion, miscarriage, abdominal trauma)

• #96 FIGO/ICM guidelines for preventing Rhesus disease: A call to action

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7898700/

  The introduction of antiRh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. […] The aim of the present study was to summarize data on the prevention of Rh disease by immunoprophylaxis and provide guidelines that take into consideration the costeffectiveness of the different dose regimens and prioritize the administration of antiRh(D) by indication. […] Determine the maternal Rh factor, preferably in early pregnancy. […] Administer antiRh(D) immunoglobulin within 72 hours of delivery to women with a Rh(D)positive newborn, unless already sensitized. […] Routine antiRh(D) prophylaxis during pregnancy: 1500 IU (300 g) at 2834 weeks. […] AntiRh(D) immunoglobulin prophylaxis (500 IU; 100 g) after a surgical abortion or ectopic pregnancy (all gestational ages), or after spontaneous or medical abortion/miscarriage after 10 weeks.

• #97 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

• #98 Consortium for Universal Rh disease Elimination (CURhE) | Division of Neonatal and Developmental Medicine | Stanford Medicine

  https://med.stanford.edu/content/sm/neonatology/Research/POTR/consortium-for-universal-rh-disease-elimination–curhe-.html

  Every year hundreds of thousands of babies, especially across Africa and Asia, are injured or die of Rh disease because their mothers were not given one or two simple injections just before or after giving birth. […] Rh disease has been virtually eliminated in wealthier nations, thanks to a simple and inexpensive prophylactic immunization developed almost fifty years ago. […] Global implementation of well-documented prevention methods of Rh disease in order to reduce childhood neurological burden and perinatal deaths. […] For every Rh-negative woman to have unfettered prenatal access to counseling and prophylaxis. […] The knowledge, talent and resources of this coalition will allow accurate identification of the Rh disease problem in various countries, effective collaboration with local government and health officials, creative awareness campaigns, and affordable delivery of the needed prophylactic treatment.

• #99 Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235807

  The enormous lack of prevention identified in the current study should be regarded as a global emergency due to a lack of maternal accessibility to IgG anti-Rh(D). As such, cooperation between health authorities, the pharmaceutical industry, and the relevant healthcare providers (e.g., physicians, nurses, midwives) is urgently needed to monitor the ongoing status of this worldwide gap and to guarantee access to, at least, post-partum immunoprophylaxis for all Rh(D)-negative women who deliver an Rh(D)-positive baby.

• #100 Celebrating 50 years of Rh prevention; successes and failures | Figo

  https://www.figo.org/news/celebrating-50-years-rh-prevention-successes-and-failures

  Currently, thanks to Anti-D, cases of HDFN registered annually in more developed countries are rare and Anti-D immunoglobulins are considered the standard of care for preventing Hemolytic Disease in all of North America, Europe and Australia. […] Although Anti-D Immunoglobulins are on the World Health Organisations List of Essential Medicines, many of the countries where this preventative treatment is most needed lack access to this prophylaxis, do not have appropriately trained medical personnel, or other resources needed to enact the necessary protocols. […] Anti-D Immunoglobulins have nearly eradicated HDFN in the developed world. However, the implementation of protocols for the sustained use of Anti-D has been insufficient in much of the developing world, resulting in some 300,000 infants dying or being severely handicapped annually, 50 years after its introduction. […] We believe we can solve this devastating problem through three simple steps: Raising public awareness of the risks of the disease, Routine blood type testing of all pregnant women, Providing free and unfettered access to Rh Immunuglobulin Prophylaxis.

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