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Antenatal Rh Immune Globulin Dose, Timing, and Indications After Selected Procedures and Complications: A Scoping
Laura Tapley1, Lani Lieberman2, Gwen Clarke3
1Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC; Department of Pathology and Laboratory Medicine, Interior Health, Kelowna General Hospital, Kelowna, BC.
Objective:
Studies addressing RhD alloimmunization after antenatal procedures and complications are limited, and practice of RhD immune globulin (RhIG) administration after these events is variable. Our objective was to assess evidence for RhIG efficacy for RhD-negative pregnancies after selected antenatal events.
Data Sources:
Literature was sourced from databases, including MEDLINE, EMBASE, Cochrane Evidence Based Medical Reviews, and Cumulative Index to Nursing and Allied Health Literature (1946 to August 2024).
Study Selection:
Studies included those focused on RhIG effectiveness after antenatal procedures or complications.
Data Extraction And Synthesis:
A total of 31 papers focused on alloimmunization risk and RhIG administration in the setting of antenatal procedures or events including chorionic villus sampling (5), amniocentesis (15), external cephalic version (5), ectopic pregnancy (1), trauma (2), and placenta previa and placental abruption (3). Most were retrospective or prospective observational trials conducted before 1995 and variable in size, quality, methodology, and outcome parameters. Papers evaluated alloimmunization (11) or fetal-maternal hemorrhage (21) as a surrogate outcome and found that all interventions and/or complications increased risk of RhD alloimmunization.
Conclusion:
The available literature supports RhIG prophylaxis for the listed procedures and complications. Data are limited by low methodologic quality, are frequently based on surrogate markers of alloimmunization, and reflect outcomes after antiquated procedures and techniques. With limited RhIG supply and a cautious approach to blood product administration, the general support for RhIG prophylaxis should be re-evaluated with high-quality trials.
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