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Anti-D administration in pregnancy for preventing rhesus alloimmunisation
1Department of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, King William Road, Adelaide, South Australia, Australia, SA 5006. ccrowthe@medicine.adelaide.edu.au
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Antenatal anti-D immunoglobulin given at 28 and 34 weeks gestation can significantly reduce RhD alloimmunisation risk in Rhesus negative mothers. This prophylaxis lowers the risk from 1.5% to 0.2% in first pregnancies without adverse effects.
Area of Science:
- Obstetrics and Gynecology
- Immunology
- Perinatal Medicine
Background:
- RhD alloimmunisation can occur in Rh-negative mothers carrying an Rh-positive fetus, typically after 28 weeks of gestation.
- This immune response can lead to complications in subsequent pregnancies.
Purpose of the Study:
- To evaluate the effectiveness of antenatal anti-D immunoglobulin prophylaxis in preventing RhD alloimmunisation.
- To assess the impact of administering anti-D at or after 28 weeks of gestation to Rh-negative mothers without existing anti-D antibodies.
Main Methods:
- Systematic review of randomized controlled trials comparing anti-D prophylaxis with placebo or no treatment.
- Searches conducted in the Cochrane Pregnancy and Childbirth Group trials register and Cochrane Controlled Trials Register (up to December 1998).
- Data extraction performed by one reviewer and double-entered for accuracy.
Main Results:
- Two trials involving over 4500 women were analyzed.
- While trends suggested reduced immunisation, statistical significance was not reached for all outcomes with standard dosing.
- A higher dose of anti-D (100ug; 500IU) given at 28 and 34 weeks showed a significant reduction in RhD immunisation 2-12 months post-birth (OR 0.22).
- No significant differences in neonatal jaundice incidence were observed.
Conclusions:
- Antenatal administration of 100ug (500IU) anti-D at 28 and 34 weeks gestation can decrease the risk of RhD alloimmunisation in first pregnancies from approximately 1.5% to 0.2%.
- This prophylactic measure appears safe, with no adverse effects reported to date.
- While not improving the current pregnancy outcome, it reduces the risk of sensitization for future pregnancies.
- Cost-effectiveness and supply considerations are important for policy adoption.