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Anti-D prophylaxis for rhesus D (RhD)-negative women having an abortion of a pregnancy up to 13+6 weeks’ gestation: a systematic review and new NICE consensus guidelines
  1. Mia Schmidt-Hansen1,
  2. Jonathan Lord2,
  3. James Hawkins1,
  4. Sharon Cameron3,
  5. Anuja Pandey1,
  6. Elise Hasler1,
  7. Fiona Regan4
  1. 1 National Guideline Alliance, Royal College of Obstetricians & Gynaecologists, London, UK
  2. 2 Department of Obstetrics & Gynaecology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
  3. 3 Sexual and Reproductive Health Services, NHS Lothian, Edinburgh, UK
  4. 4 Department of Haematology, Imperial College Healthcare NHS Trust and NHS Blood & Transplant, London, UK
  1. Correspondence to Dr Mia Schmidt-Hansen, National Guideline Alliance, Royal College of Obstetricians & Gynaecologists, London SE1 1SZ, UK; MSchmidt-Hansen{at}


Background In order to develop the 2019 National Institute for Health and Care Excellence (NICE) national guideline on abortion care for the National Health Service1 we undertook a systematic review comparing anti-D prophylaxis to no prophylaxis in rhesus D (RhD)-negative women undergoing medical or surgical abortion of pregnancy at ≤13+6 weeks’ gestation

Methods We searched Embase, Medline and the Cochrane Library on 19 October 2018. We also consulted experts and checked reference lists for any missed trials. Eligible studies were randomised controlled trials and non-randomised comparative studies, published in English from 1985 onwards, comparing anti-D prophylaxis to no anti-D prophylaxis in RhD-negative women undergoing medical or surgical abortion at ≤13+6 weeks’ gestation, and reporting subsequent anti-D isoimmunisation/sensitisation or subsequent affected pregnancy. These outcomes were to be analysed as risk ratios in Review Manager 5.3 using the Mantel-Haenszel statistical method and a fixed or random effect model. The overall quality of the evidence was planned to be assessed using GRADE.

Results The search identified 426 potentially relevant studies of which none met the inclusion criteria. Recommendations for practice were therefore based on the clinical expertise of the guideline committee.

Conclusions (1) Offer anti-D prophylaxis to women who are Rhesus D negative who are having an abortion after 10+0 weeks’ gestation. (2) Do not offer anti-D prophylaxis to women who are having a medical abortion up to and including 10+0 weeks’ gestation. (3) Consider anti-D prophylaxis for women who are rhesus D negative and are having a surgical abortion up to and including 10+0 weeks’ gestation.

  • abortion

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  • Contributors FR, JL, SC, EH and MSH conceived and designed the review and wrote the protocol. EH devised and undertook the search strategy. MSH screened the search results. JH performed the economic analyses. FR, JL, MSH, AP, JH, SC and EH wrote the first draft of different sections of the full review. All the authors critically revised the first draft of the review and approved the final version of the review. MSH is the guarantor.

  • Funding This article presents a systematic review undertaken as part of the 2019 NICE guideline on abortion care. This work was undertaken by the National Guideline Alliance (NGA) at the Royal College of Obstetricians & Gynaecologists (RCOG), which received funding from the National Institute for Health and Care Excellence (NICE). The funding body (NICE) did not play any direct role in the study design; the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The views expressed in this publication are those of the authors and not necessarily those of the NGA, RCOG or NICE. All researchers involved in this work were independent from the funding body at the time of completing this work. The authors would like to thank NICE, the National Guideline Alliance and the Guideline Committee for the ‘Abortion Care’ NICE Guideline (2019).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.