Title |
Anti-D administration in pregnancy for preventing Rhesus alloimmunisation
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Published by |
John Wiley & Sons, Ltd, April 1999
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DOI | 10.1002/14651858.cd000020 |
Pubmed ID | |
Authors |
Crowther, Caroline A, Middleton, Philippa |
Abstract |
A woman may develop Rh-negative antibodies during her first pregnancy when her fetus is Rh-positive. Antibodies develop most frequently after the 28th week of gestation. The objective of this review was to asses the effects of giving antenatal anti-D immunoglobulin at 28 weeks or more of pregnancy on the incidence of RhD alloimmunisation when given to Rhesus negative mothers without anti-D antibodies. We searched the Cochrane Pregnancy and Childbirth Group trials register, Cochrane Controlled Trials Register, and bibliographies. Date of last search: December 1998. Randomised trials in Rhesus negative women without anti-D antibodies given anti-D after 28 weeks of pregnancy, compared with no treatment or placebo. Data were extracted by one reviewer and double entered. Two eligible trials, which involved over 4500 women, compared anti-D prophylaxis with no treatment. Although the data suggested, when women receive anti-D at 28 and 34 weeks gestation, a reduced incidence of immunisation during pregnancy (0R O.44, 95% CI 0.18-1.12), after the birth of a Rhesus positive infant (OR 0.44, 95% CI 0.18-1.12), and within 12 months after birth of a Rhesus positive infant (OR 0.44, 95% CI 0.19-1.01), none of these differences were statistically significant. In the trial, which used the larger dose of anti-D (100ug; 500IU), there was a clear reduction in the incidence of immunisation at 2-12 months following birth in women who had received Anti-D at 28 and 34 weeks (OR 0.22 95% CI 0.05-0.88). No data were available for the risk of RhD alloimmunisation in a subsequent pregnancy. No differences were observed in the incidence of neonatal jaundice. The risk of RhD alloimmunisation during or immediately after a first pregnancy is about 1.5%. Administration of 100ug (500IU) anti-D at 28 weeks and 34 weeks gestation to women in their first pregnancy can reduce this risk to about 0.2% without, to date, any adverse effects. Although such a policy is unlikely to confer benefit or improve outcome in the present pregnancy, fewer women will have Rhesus D antibodies in their next pregnancy. Adoption of such a policy will need to consider the costs of prophylaxis against the costs of care for women who become sensitised and their affected infants, and local adequacy of supply of anti-D gammaglobulin. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 2 | 5% |
Colombia | 1 | 2% |
Ireland | 1 | 2% |
Unknown | 39 | 91% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Ph. D. Student | 7 | 16% |
Researcher | 7 | 16% |
Student > Bachelor | 4 | 9% |
Other | 4 | 9% |
Student > Master | 4 | 9% |
Other | 10 | 23% |
Unknown | 7 | 16% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 17 | 40% |
Nursing and Health Professions | 4 | 9% |
Biochemistry, Genetics and Molecular Biology | 4 | 9% |
Social Sciences | 3 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 2 | 5% |
Other | 5 | 12% |
Unknown | 8 | 19% |