Administration of Routine Antenatal Anti-D Prophylaxis (RAADP) in Wellington, Aotearoa: is our practice equitable?

To assess local compliance with Routine Antenatal Anti-D Prophylaxis (RAADP) guidelines and to determine if its administration is equitable in Wellington, Aotearoa New Zealand.

A retrospective 6-month audit of people birthing in Wellington maternity units. Rhesus-negative people were identified and electronic heath records reviewed.

Two hundred and nine out of 1,881 (11%) of people birthing were Rhesus-negative. Two hundred and five people were included in the audit. Three people were excluded as they birthed prior to 28 weeks, and one was already isoimmunised. One became isoimmunised during pregnancy. Eighty-three out of 205 (40%) received RAADP as per guidelines. Factors that made it more likely for people to receive RAADP were private obstetrician care (78% versus 34%, p<0.01), living closer to hospital (p<0.01) and birthing in Wellington Hospital (43% versus 11% in a primary unit, p<0.01). There is no evidence that management was influenced by ethnicity, mode of birth, parity, age or attendance at a hospital antenatal clinic.

RAADP guidelines are not being followed and some subgroups are disproportionately affected. There is evidence of harm, with one person becoming isoimmunised during pregnancy. Simplifying local protocols, establishing more sites for RAADP administration such as pharmacies or primary units and improving staff and patient education could help to address these inequities.