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Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study
Author(s) -
MacKenzie I. Z.,
Bowell Peter,
Gregory Helen,
Pratt Geoff,
Guest Claire,
Entwistle C. C.
Publication year - 1999
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1999.tb08304.x
Subject(s) - medicine , gestation , serology , population , pregnancy , obstetrics , pediatrics , prospective cohort study , antibody , immunology , environmental health , genetics , biology
Objective To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae. Design A retrospective (1980–1986) and prospective (1987–1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time. Setting Obstetric units in two counties (three health districts) with similar annual numbers of matemities and the Regional Blood Transfusion Service antenatal serology laboratory. Participants Non‐sentisitised Rhesus D negative pregnant nulliparae. Interventions Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county. Main outcome measures 1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme. Results Prophylaxis significantly reduced iso‐immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14–0.53; P < 0.0001 ) and contemporary controls (OR 0.43, CI 0.22–0.86; P = 0.02 ). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty‐two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill‐health that result from very preterm birth should be considerable. Conclusion Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.