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. 2000;1997(2):CD000021.
doi: 10.1002/14651858.CD000021.

Anti-D administration after childbirth for preventing Rhesus alloimmunisation

C Crowther  1 , P Middleton
Affiliations

Anti-D administration after childbirth for preventing Rhesus alloimmunisation

C Crowther et al. Cochrane Database Syst Rev. 2000.

Abstract

Background: The development of Rh immunisation and its prophylactic use since the 1970s has meant that severe Rhesus D (RhD) alloimmunisation is now rarely seen.

Objectives: The objective of this systematic review was to assess the effects of giving anti-D to Rhesus negative women, with no anti-D antibodies, who had given birth to a Rhesus positive infant.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, MEDLINE (from 1966 to January 1999) and reference lists of relevant articles. Date of last search of Cochrane Controlled Trials Register: January 1999.

Selection criteria: Randomised trials in Rhesus negative women without antibodies who were given anti-D immunoglobulin postpartum compared with no treatment or placebo.

Data collection and analysis: Assessments of inclusion criteria, trial quality and data extraction were done by each author independently. Initial analyses included all trials. Other analyses assessed the effect of trial quality, ABO compatibility and dose.

Main results: Six eligible trials compared postpartum anti-D prophylaxis with no treatment or placebo. The trials involved over 10,000 women, but trial quality varied. Anti-D lowered the incidence of RhD alloimmunisation six months after birth (relative risk 0.04, 95% confidence interval 0.02 to 0.06), and in a subsequent pregnancy (relative risk 0.12, 95% confidence interval 0. 07 to 0.23). These benefits were seen regardless of the ABO status of the mother and baby and when anti-D was given within 72 hours of birth. Higher doses (up to 200 micro grams) were more effective than lower doses (up to 50 micro grams) in preventing RhD alloimmunisation in a subsequent pregnancy.

Reviewer's conclusions: Anti-D, given within 72 hours after childbirth, reduces the risk of RhD alloimmunisation in Rhesus negative women who have given birth to a Rhesus positive infant. However the evidence on the optimal dose is limited.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Anti‐D prophylaxis postpartum (overall, irrespective of ABO status), Outcome 1 Immunisation after 6 months.
1.2
1.2. Analysis
Comparison 1 Anti‐D prophylaxis postpartum (overall, irrespective of ABO status), Outcome 2 Immunisation in subsequent pregnancy.
2.1
2.1. Analysis
Comparison 2 Anti‐D prophylaxis postpartum (ABO compatible, irrespective of dose), Outcome 1 Immunisation after 6 months.
2.2
2.2. Analysis
Comparison 2 Anti‐D prophylaxis postpartum (ABO compatible, irrespective of dose), Outcome 2 Immunisation in subsequent pregnancy.
3.1
3.1. Analysis
Comparison 3 Anti‐D prophylaxis postpartum, up to 200 ug versus no treatment, Outcome 1 Immunisation after 6 months.
3.2
3.2. Analysis
Comparison 3 Anti‐D prophylaxis postpartum, up to 200 ug versus no treatment, Outcome 2 Immunisation at subsequent pregnancy.
4.1
4.1. Analysis
Comparison 4 Anti‐D prophylaxis postpartum, up to 250 ug versus no treatment, Outcome 1 Immunisation after six months.
4.2
4.2. Analysis
Comparison 4 Anti‐D prophylaxis postpartum, up to 250 ug versus no treatment, Outcome 2 Immunisation at subsequent pregnancy.
5.1
5.1. Analysis
Comparison 5 Anti‐D prophylaxis postpartum, up to 300 ug versus no treatment, Outcome 1 Immunisation after 6 months.
5.2
5.2. Analysis
Comparison 5 Anti‐D prophylaxis postpartum, up to 300 ug versus no treatment, Outcome 2 Immunisation at subsequent pregnancy.
6.1
6.1. Analysis
Comparison 6 Anti‐D prophylaxis postpartum, 4000‐7000 ug versus no treatment, Outcome 1 Immunisation after 6 months.
6.2
6.2. Analysis
Comparison 6 Anti‐D prophylaxis postpartum, 4000‐7000 ug versus no treatment, Outcome 2 Immunisation at subsequent pregnancy.
7.1
7.1. Analysis
Comparison 7 Dosage comparison, up to 50 ug versus more than 50 ug anti‐D, Outcome 1 Immunisation after 6 months.
7.2
7.2. Analysis
Comparison 7 Dosage comparison, up to 50 ug versus more than 50 ug anti‐D, Outcome 2 Immunisation in subsequent pregnancy.
8.1
8.1. Analysis
Comparison 8 Dosage comparison, up to 100 ug versus more than 100 ug anti‐D, Outcome 1 Immunisation after 6 months.
8.2
8.2. Analysis
Comparison 8 Dosage comparison, up to 100 ug versus more than 100 ug anti‐D, Outcome 2 Immunisation in subsequent pregnancy.
9.1
9.1. Analysis
Comparison 9 Dosage comparison, up to 150 ug versus more than 150 ug anti‐D, Outcome 1 Immunisation after 6 months.
9.2
9.2. Analysis
Comparison 9 Dosage comparison, up to 150 ug versus more than 150 ug anti‐D, Outcome 2 Immunisation in subsequent pregnancy.
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References

References to studies included in this review

International 1966 {published data only}
    1. Ascari WQ, Allen AE, Baker WJ, Pollack W. Rho (D) immune globulin (human); evaluation in women at risk of Rh immunization. JAMA 1968;205(1):71‐4. - PubMed
    1. Ascari WQ, Levine, P, Pollack W. Incidence of maternal Rh immunization by ABO compatible and incompatible pregnancies. BMJ 1969;1:399‐401. - PMC - PubMed
    1. Bishop GJ, Krieger VI. One millilitre injections of Rho (D) immune globulin (human) in the prevention of Rh immunization: a further report on the clinical trial. Medical Journal of Australia 1969;2:171‐4. - PubMed
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Liverpool 1971 {published data only}
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MRC 1974 {published data only}
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Netherlands 1968 {published data only}
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    1. Clarke CA. Prophylaxis of Rhesus iso‐immunization. British Medical Bulletin 1968;24(1):3‐9.
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References to studies excluded from this review

Beer 1969 {published data only}
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Hamilton 1967 {published data only}
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Additional references

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References to other published versions of this review

CDSR 1997
    1. Crowther C, Middleton P. Anti‐Rh‐D prophylaxis postpartum. In: Neilson JP, Crowther CA, Hodnett ED, Hofmeyr GJ, Keirse MJNC (eds) Pregnancy and Childbirth Module of The Cochrane Database of Systematic Reviews, [updated April 1997]. Available in The Cochrane Library [database on disk and CDROM]. The Cochrane Collaboration; Issue 2. Oxford: Update Software; 1997.
CDSR 1999
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Crowther 1995a
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Crowther 1995b
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Crowther 1995c
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Crowther 1995d
    1. Crowther CA, Keirse MJNC. <200ug Anti‐Rh‐D postpartum vs higher doses [revised 16th November 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.

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