Open AccessTargeted antenatal anti‐D prophylaxis program for RhD‐negative pregnant women – outcome of the first two years of a national program in Finland
Author(s) -
Haimila Katri,
Sulin Kati,
Kuosmanen Malla,
Sareneva Inna,
Korhonen Anu,
Natunen Suvi,
Tuimala Jarno,
Sainio Susanna
Publication year - 2017
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13191
Subject(s) - medicine , discontinuation , obstetrics , fetus , pregnancy , antenatal screening , confidence interval , prospective cohort study , genotyping , gestation , pediatrics , serology , antibody , immunology , surgery , genotype , biochemistry , chemistry , genetics , gene , biology
The aim of this study was to assess the accuracy of the non‐invasive fetal RHD test at 24–26 weeks of gestation as part of the national antenatal screening program to target routine antenatal anti‐D prophylaxis ( RAADP ) at 28–30 weeks at women carrying an RhD‐positive fetus. Material and methods A prospective cohort study involving all maternity care centers and delivery hospitals in Finland between February 2014 and January 2016. Fetal RHD genotyping using cell‐free fetal DNA in maternal plasma was performed with real‐time polymerase chain reaction in a centralized setting. The results were systematically compared with the serological newborn RhD typing. The main outcome measure was the accuracy of the fetal RHD assay; the secondary variable was compliance with the newly introduced RAADP program. Results Fetal RHD was screened from 10 814 women. For the detection of fetal RHD , sensitivity was 99.99% [95% confidence interval (CI) 99.92–99.99] and specificity 99.81% (95% CI 99.60–99.92). One false‐negative and seven false‐positive results were reported by the delivery hospitals in two years. The negative predictive value of the test was 99.97% (95% CI 99.81–99.99). At the end of the study period, over 98% of the RhD‐negative women participated in the new screening program. Conclusions The targeted RAAPD program was implemented effectively in the national maternity care program in Finland. An accurate fetal RHD screening test allows discontinuation of newborn testing without risking the postnatal prophylaxis program. In the future, the main area to investigate will be the clinical effect of RAADP on subsequent pregnancies.