Rhesus D Prophylaxis: When and Why We Give Rhesus D Immunoglobulin

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Perinatal Medicine

Background:

• Hemolytic disease of the fetus and newborn (HDFN) arises from maternal alloantibodies targeting fetal red blood cells, causing significant morbidity and mortality.
• Rhesus D antigen (RhD)-mediated HDFN is a preventable cause of alloimmunization during pregnancy, with RhD prophylaxis drastically reducing risks.

Purpose of the Study:

• To highlight the importance of RhD prophylaxis.
• To detail guideline-directed indications for RhD immunoglobulin (RhDIg) administration.
• To clarify uncertainties and review concepts for patient education and shared decision-making.

Main Methods:

• A literature search was conducted using PubMed and Google Scholar.
• Key concepts, current guidelines, and areas of debate regarding RhD prophylaxis were summarized and discussed.

Main Results:

• Prenatal and postpartum RhD prophylaxis has significantly decreased HDFN incidence and morbidity over decades.
• International guidelines advocate routine prophylaxis for Rh-negative mothers in the second trimester and postpartum, with additional doses after high-risk events.
• Recent RhDIg shortages and fetal blood typing advancements have spurred debate on first-trimester prophylaxis criteria.

Conclusions:

• Understanding RhD prophylaxis indications is vital for preventing RhD alloimmunization.
• Prophylaxis is strongly recommended for Rh-negative mothers in the second trimester, after high-risk events, and postpartum, despite some clinical uncertainties.