The use of anti-D prophylaxis in the management of miscarriage in general practice

Deaths from rhesus (Rh) haemolytic disease dropped steeply after anti-D immunoglobin became available for prophylaxis in Britain in 1969. Nevertheless, Rh incompatibility remains a cause of perinatal mortality and some unregistered fetal deaths before 28 weeks gestation. Some of these deaths are attributed to a failure to administer anti-D immunoglobin in the appropriate circumstances. The prophylactic administration of anti-D immunoglobin to Rh negative women or women whose Rh type was unknown was explored as part of a survey of the management of miscarriage in general practitioner training practices in the West of Scotland. Trainees were found to be the most likely, and general practitioners who had qualified before 1970 the least likely to offer anti-D prophylaxis. The advice of the Health Departments is currently unambiguous about the need to administer anti-D immunoglobin after miscarriage. The findings described here indicate the need to implement this advice more effectively until the question of first trimester sensitisation has been resolved.