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Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis
Article first published online: 17 JUN 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 10, pages 1307–1314, September 2009
How to Cite
Koelewijn, J., de Haas, M., Vrijkotte, T., van der Schoot, C. and Bonsel, G. (2009), Risk factors for RhD immunisation despite antenatal and postnatal anti-D prophylaxis. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1307–1314. doi: 10.1111/j.1471-0528.2009.02244.x
- Issue published online: 10 AUG 2009
- Article first published online: 17 JUN 2009
- Accepted 23 April 2009. Published Online 17 June 2009.
- RhD pregnancy immunisation;
- risk factors
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.
Population 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 (≥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.