Obstetrical & gynecological survey · 2025
Rhesus D Prophylaxis: When and Why We Give Rhesus D Immunoglobulin.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
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Schwalb Allison M, Federspiel Jerome J, Dotters-Katz Sarah, Kuller Jeffrey A, Sugrue Ronan P
Аннотация
IMPORTANCE: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibodies to fetal red blood cells and is associated with significant fetal and neonatal morbidity and mortality. Rhesus D antigen (RhD)-mediated HDFN is the only preventable cause of alloimmunization in pregnancy. Widespread utilization of RhD prophylaxis reduces the risk of RhD-mediated alloimmunization from 17% to <1% in at-risk pregnancies, although RhD-mediated HDFN still occurs.
OBJECTIVE: To emphasize significance of RhD prophylaxis, outline current guideline-directed indications for administration, provide clarification in areas of uncertainty regarding prophylaxis administration, and review key concepts relevant to patient education and shared decision-making.
EVIDENCE ACQUISITION: PubMed and Google Scholar literature search.
RESULTS: Data over several decades have shown implementation of prenatal and postpartum RhD prophylaxis has significantly reduced incidence and morbidity of RhD-mediated HDFN. Most international guidelines recommend routine prophylaxis of Rh-negative mothers in the second trimester and peripartum, with additional prophylaxis following certain high-risk events. Recent shortages in RhD immunoglobulin (RhDIg) and new methods to determine fetal blood type have prompted renewed debate regarding criteria for prophylaxis during the first trimester.
CONCLUSION: Understanding indications for administration of RhD prophylaxis is essential for preventing RhD alloimmunization. Although uncertainty remains in some clinical scenarios, prophylaxis is strongly recommended in Rh-negative mothers in the second trimester, following events high-risk for sensitization in pregnancy, and postpartum.
RELEVANCE: In this review, the etiology of alloimmunization and indications for RhDIg prophylaxis, current society recommendations, and areas of debate are summarized and discussed.
OBJECTIVE: To emphasize significance of RhD prophylaxis, outline current guideline-directed indications for administration, provide clarification in areas of uncertainty regarding prophylaxis administration, and review key concepts relevant to patient education and shared decision-making.
EVIDENCE ACQUISITION: PubMed and Google Scholar literature search.
RESULTS: Data over several decades have shown implementation of prenatal and postpartum RhD prophylaxis has significantly reduced incidence and morbidity of RhD-mediated HDFN. Most international guidelines recommend routine prophylaxis of Rh-negative mothers in the second trimester and peripartum, with additional prophylaxis following certain high-risk events. Recent shortages in RhD immunoglobulin (RhDIg) and new methods to determine fetal blood type have prompted renewed debate regarding criteria for prophylaxis during the first trimester.
CONCLUSION: Understanding indications for administration of RhD prophylaxis is essential for preventing RhD alloimmunization. Although uncertainty remains in some clinical scenarios, prophylaxis is strongly recommended in Rh-negative mothers in the second trimester, following events high-risk for sensitization in pregnancy, and postpartum.
RELEVANCE: In this review, the etiology of alloimmunization and indications for RhDIg prophylaxis, current society recommendations, and areas of debate are summarized and discussed.