Hl. Howard et al., PREVENTING RHESUS-D HEMOLYTIC-DISEASE OF THE NEWBORN BY GIVING ANTI-DIMMUNOGLOBULIN - ARE THE GUIDELINES BEING ADEQUATELY FOLLOWED, British journal of obstetrics and gynaecology, 104(1), 1997, pp. 37-41
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.