Rhesus testing and anti-D prophylaxis in RhD-negative women undergoing first-trimester abortion-Systematic Review and...

Area of Science:

• Obstetrics and Gynecology
• Immunology
• Perinatal Medicine

Background:

• Immunoglobulin G (IgG) anti-D prophylaxis significantly reduced RhD alloimmunization and hemolytic disease of the fetus and newborn.
• Evidence for routine anti-D prophylaxis in first-trimester abortions is limited.
• Current practices vary, necessitating a review of guidelines and literature.

Purpose of the Study:

• To analyze international and national evidence-based guidelines on Rh testing and anti-D prophylaxis in first-trimester abortions.
• To review literature supporting or opposing this practice.
• To facilitate informed clinical decision-making.

Main Methods:

• Systematic literature search of multiple databases (PubMed, EMBASE, Cochrane, Google Scholar) from 2003 to 2024.
• Inclusion of guidelines, reviews, meta-analyses, observational studies, RCTs, real-world data, and cohort studies.
• Independent screening and data extraction by two authors.

Main Results:

• Recent guidelines (e.g., WHO, 2022 onwards) recommend against anti-D for first-trimester abortions.
• Older guidelines often recommended RhD testing and anti-D prophylaxis before 12 weeks, with varying gestational age thresholds.
• Discrepancies stem from differing evidence interpretation, availability, and socio-legal factors.

Conclusions:

• There is a need for evidence-based, harmonized guidelines on IgG anti-D prophylaxis in first-trimester abortions.
• Healthcare providers must stay updated on the latest recommendations.
• Shared decision-making with patients is crucial for managing RhD-negative women undergoing first-trimester abortion.