Use of anti-D immunoglobulin in the treatment of threatened miscarriage inthe accident and emergency department

Background-The UK guidelines for the use of anti-D immunoglobulin for rhesu s prophylaxis have been revised. Anti-D immunoglobulin is no longer recomme nded for Rh D negative women after a threatened miscarriage less than 12 we eks gestation. These patients are at risk of rhesus immunisation, and there should be a policy for their treatment in the accident and emergency (A&E) department. Design-A retrospective study over a 17 month period was conducted looking a t women less than 12 weeks gestation who presented to an A&E department wit h a threatened miscarriage. Objectives-To determine how many of these patients presented with heavy or repeated bleeding, or abdominal pain, and whether the guidelines for the us e of rhesus prophylaxis were followed. Results-112 women fulfilled the criteria for inclusion. Nineteen patients w ere Rh D negative. Eighty three patients (74.1%) presented with either abdo minal pain or heavy or recurrent bleeding. Rhesus status was recorded in th e A&E notes in only 15 patients (13.3%). Ninety seven patients (86.6 %) wer e discharged without rhesus status being checked. Fifteen Rh D negative pat ients were discharged without being offered anti-D immunoglobulin. Conclusion-Many women who present to the A&E department with a threatened m iscarriage of less than 12 weeks gestation have heavy or recurrent bleeding or associated abdominal pain. These patients have an increased risk of fet omaternal haemorrhage and the consequent development of haemolytic disease of the newborn is possible. It should be mandatory for the A&E department t o record rhesus status. In the context of A&E medicine, anti-D immunoglobul in should still be offered to all non-immune Rh D negative women presenting with a threatened miscarriage less than 12 weeks gestation.