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Time to re-evaluate rhesus testing and anti-D prophylaxis in abortion care
  1. Jonathan Lord1,2
  1. 1 Marie Stopes International (UK), London, UK
  2. 2 Department of Gynaecology, Royal Cornwall Hospitals NHS Trust, Truro, UK
  1. Correspondence to Jonathan Lord, UK, Marie Stopes International (UK), London W1T 6LP, UK; j.lord{at}

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The introduction of anti-D immunoglobulin (Ig) has been one of the great achievements in medicine over the past 50 years.1 Its use has reduced the incidence of alloimmunisation by 85% where formerly about 10% of pregnancies were affected.2 3 Whereas previously 38% of affected neonates would have died, now haemolytic disease of the newborn is a very rare cause of death in developed countries.1

Although the value of anti-D prophylaxis in routine antenatal care in women who are rhesus (RhD)-negative is evidence-based,4 its role in first-trimester abortion and miscarriage management is not. National guidelines are inconsistent and have been based on observational studies from over 40 years ago when practices were quite different5 (table 1). When the scope for the National Institute for Health and Care Excellence (NICE) abortion care guideline was being developed,6 stakeholders rated the role of anti-D prophylaxis as one of the most important topics to be included.

View this table:
Table 1

Examples of national guidelines for recommended use of anti-D in the first trimester

The systematic review and rationale for the NICE guideline is published in this edition of the journal.7 With no evidence of either benefit from use of anti-D in abortion care, or harm if it is not given in the first trimester, NICE has challenged the traditional stance of many national guidelines that recommend using anti-D because of historic practice. The recommendation from NICE not to give anti-D to women having a medical abortion up to 10 weeks’ gestation reversed previous practice and was swiftly implemented by abortion providers across the UK.

Why the change?

The main reason to continue …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests National Health Service (NHS) clinician representative of the National Institute for Health and Care Excellence (NICE) abortion care guideline (NG140) and co-author of the systematic review referenced in this editorial.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned, externally peer reviewed.