British journal of obstetrics and gynaecology · 1997
Preventing Rhesus D haemolytic disease of the newborn by giving anti-D immunoglobulin: are the guidelines being adequately followed?
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Howard H L, Martlew V J, McFadyen I R, Clarke C A
Аннотация
OBJECTIVE: To ascertain whether anti-D immunoglobulin is being administered to Rhesus D negative women in accordance with the 1991 recommendations for its use to cover all events which may result in fetomaternal haemorrhage.
DESIGN: The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations.
SETTING: Seven maternity units using a central antenatal screening service.
PARTICIPANTS: Nine hundred and twenty-two Rhesus D negative women delivered in these seven hospitals.
MAIN OUTCOME MEASURES: The prescription, dosage and indications for administration of anti-D immunoglobulin to women during pregnancy and in the puerperium.
RESULTS: Postnatal anti-D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti-D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 i.u. was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a 'negative' result interpreted as a reason not to give anti-D immunoglobulin.
CONCLUSION: Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000-1500 i.u.), both of which would increase the requirements for this limited resource.
DESIGN: The notes of women delivered in 1994 were examined for compliance with the 1991 recommendations.
SETTING: Seven maternity units using a central antenatal screening service.
PARTICIPANTS: Nine hundred and twenty-two Rhesus D negative women delivered in these seven hospitals.
MAIN OUTCOME MEASURES: The prescription, dosage and indications for administration of anti-D immunoglobulin to women during pregnancy and in the puerperium.
RESULTS: Postnatal anti-D immunoglobulin was given in appropriate doses to more than 95% of women who required it. Omissions mainly arose from confusion among women who recently had received antenatal treatment with anti-D immunoglobulin. The 1991 recommendations for antenatal administration were less closely followed. Abdominal trauma was covered in only 20% of cases. An inadequate dosage of 250 i.u. was given to 25 women for antepartum haemorrhage after 20 weeks of gestation. The purpose of the Kleihauer test was sometimes poorly understood, with a 'negative' result interpreted as a reason not to give anti-D immunoglobulin.
CONCLUSION: Closer adherence to the 1991 recommendations might further reduce the incidence of Rhesus D immunisation below the current 1%. It is suggested that more careful application of the recommendations should be evaluated before considering either routine antenatal prophylaxis, or the European recommendation of a larger dose (1000-1500 i.u.), both of which would increase the requirements for this limited resource.