EDITORIAL INTRODUCTION

Authors

  • Dr S. J. Urbaniak


It is 20 years since the last international gathering of experts to discuss anti-D prophylaxis (McMaster Conference 1977)1 and since then relatively little has changed with respect to the incidence of failures of anti-D prophylaxis which remain constant in the region of 1-2%. On the other hand, major advances have occurred in the monitoring and management of affected fetuses in uteru, and in neonatal intensive care. This has resulted in a very significant reduction in reported mortality associated with RhD haemolytic disease to the extent that it is not perceived as a problem any more.

However, it has long been advocated that there is significant under reporting of mortality, and there is greater appreciation of the impact of morbidity, and the resources consumed by monitoring and caring for alloimmunised women and their babies. In the UK, routine antenatal prophylaxis has been resisted on the grounds of lack of demonstrable cost-effectiveness in the UK healthcare setting, and concerns about meeting the demands for the additional anti-D required. The latter is a concern worldwide as anti-D plasma supply from donors is a finite resource, and there have been concerns about the ethics and safety of deliberate immunisation of RhD-negative volunteers. The possible early introduction of monoclonal anti-D proved to be a false dawn, and some countries have difficulties in maintaining self-sufficiency in anti-D plasma because of premature closure or reduction of anti-D immunisation programmes.

It therefore seemed timely to have a conference of interested parties to debate these issues, and to attempt to come to a consensus. The consensus framework used by the Royal College of Physicians of Edinburgh was chosen as the vehicle for a 2-day conference (held jointly with the Royal College of Obstetricians and Gynaecologists) addressing a number of specific issues. The details of the questions to be addressed, and the consensus methodology are given in a paper in this supplement, and the evidence presented to the panel is also published. This consists of the three background papers prepared in advance and the abstracts of the oral and poster presentations. The final consensus statement is published in full, together with a personal view from a panel member.

One specific objective of the Conference was to obtain a definitive statement on the position of antenatal anti-D prophylaxis in the UK, either for, or against. The session in the programme dealing with this topic was therefore chosen to be addressed with speakers chosen to speak for and against, with the opportunity for each to cross-examine the other in public, and for the panel and audience to judge the weight of evidence. This proved to be a successful format for summarising the issues for and against.

Finally, and importantly, the conference presentation and statement produced by the panel provided the UK Committee of experts charged with revising and updating the 1991 UK Guidelines on Anti-D Prophylaxis with essential information to complete their task. These revised recommendations are awaited shortly.

Ancillary