PREVENTING RHESUS-D HEMOLYTIC-DISEASE OF THE NEWBORN BY GIVING ANTI-DIMMUNOGLOBULIN - ARE THE GUIDELINES BEING ADEQUATELY FOLLOWED

Objective To ascertain whether anti-D immunoglobulin is being administ ered to Rhesus D negative women in accordance with the 1991 recommenda tions for its use to cover all events which may result in fetomaternal haemorrhage. Design The notes of women delivered in 1994 were examine d for compliance with the 1991 recommendations. Setting Seven maternit y units using a central antenatal screening service. Participants Nine hundred and twenty-two Rhesus D negative women delivered in these sev en hospitals. Main outcome measures The prescription, dosage and indic ations for administration of anti-D immunoglobulin to women during pre gnancy and in the puerperium. Results Postnatal anti-D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti-D immunoglobulin. The 1991 rec ommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosag e of 250 IU was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes po orly understood, with a 'negative' result interpreted as a reason not to give anti-D immunoglobulin. Conclusion Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immuni sation below the current 1%. It is suggested that more careful applica tion of the recommendations should be evaluated before considering eit her routine antenatal prophylaxis, or the European recommendation of a larger dose (1000-1500 IU), both of which would increase the requirem ents for this limited resource.