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. 2009 Sep;116(10):1307-14.
doi: 10.1111/j.1471-0528.2009.02244.x. Epub 2009 Jun 17.

Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis

J M Koelewijn  1 , M de Haas, T G M Vrijkotte, C E van der Schoot, G J Bonsel
Affiliations
Free PMC article

Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis

J M Koelewijn et al. BJOG. 2009 Sep.
Free PMC article

Abstract

Objective: To identify risk factors for Rhesus D (RhD) immunisation in pregnancy, despite adequate antenatal and postnatal anti-D prophylaxis in the previous pregnancy. To generate evidence for improved primary prevention by extra administration of anti-D Ig in the presence of a risk factor.

Design: Case-control study.

Setting: Nation-wide evaluation of the Dutch antenatal anti-D-prophylaxis programme.

Cases: 42 RhD-immunised parae-1, recognised by first-trimester routine red cell antibody screening in their current pregnancy, who received antenatal and postnatal anti-D Ig prophylaxis (gifts of 1000 iu) in their first pregnancy.

Controls: 339 parae-1 without red cell antibodies.

Methods: Data were collected via obstetric care workers and/or personal interviews with women.

Main outcome measure: Significant risk factors for RhD immunisation in multivariate analysis.

Results: Independent risk factors were non-spontaneous delivery (assisted vaginal delivery or caesarean section) (OR 2.23; 95% CI:1.04-4.74), postmaturity (>or=42 weeks of completed gestation: OR 3.07; 95% CI:1.02-9.02), pregnancy-related red blood cell transfusion (OR 3.51; 95% CI:0.97-12.7 and age (OR 0.89/year; 95% CI:0.80-0.98). In 43% of cases, none of the categorical risk factors was present.

Conclusions: In at least half of the failures of anti-D Ig prophylaxis, a condition related to increased fetomaternal haemorrhage (FMH) and/or insufficient anti-D Ig levels was observed. Hence, RhD immunisation may be further reduced by strict compliance to guidelines concerning determination of FMH and accordingly adjusted anti-D Ig prophylaxis, or by routine administration of extra anti-D Ig after a non-spontaneous delivery and/or a complicated or prolonged third stage of labour.

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