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Rhesus isoimmunisation in unsensitised RhD-negative individuals seeking abortion at less than 12 weeks’ gestation: a systematic review
  1. Michelle C Chan1,
  2. Roopan Kaur Gill2,
  3. Caron Rahn Kim3
  1. 1Department of Obstetrics and Gynecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  2. 2Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Michelle C Chan, Obstetrics and Gynecology, The University of British Columbia Faculty of Medicine, Vancouver, Canada; mcchan{at}ualberta.ca

Abstract

Aim The aim of this review was to systematically review the outcome of routine anti-D administration among unsensitised rhesus (RhD)-negative individuals who have an abortion. This review is registered with Prospero.

Methods A search for all published and ongoing studies, without restrictions on language or publication status, was performed using the following databases from their inception: EBM Reviews Ovid - Cochrane Central Register of Controlled Trials, MEDLINE Ovid (Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily), Embase.com, Popline and Google Scholar. Study types included: randomised controlled trials, controlled trials, cohort and case–control studies from 1971 onwards. The population included women who undergo an abortion (induced, incomplete, spontaneous or septic abortion), medical or surgical <12 weeks, and isoimmunisation in a subsequent pregnancy. The primary outcomes were: (1) development of a positive Kleihauer–Betke test and (2) development of Rh alloimmunisation in a subsequent pregnancy.

Results A total of 2652 studies were screened with 105 accessed for full-text review. Two studies have been included with high bias appreciated. Both studies found few women to be sensitised in forming antibodies after an abortion. The limited studies available and heterogeneity prevent the conduction of a meta-analysis.

Conclusions Rh immunoglobulin has well-documented safety. However, it is not without risks and costs, is a possible barrier to delivering efficient services, and may have limited availability in some countries. The evidence base and quality of studies are currently limited. There is unclear benefit from the recommendation for Rh testing and immunoglobulin administration in early pregnancy. More research is needed as clinical practice guidelines are varied, based on expert opinions and moving away from testing and administration at time of abortion.

Implications There is limited evidence surrounding medical benefit of Rh testing and immunoglobulin administration in early pregnancy. Further research is needed to define alloimmunisation and immunoglobulin benefit to update standards of care. Additionally, other factors should be considered in forming clinical policies and guidelines such as costs, feasibility and impact on access to care for patients.

  • abortion
  • incomplete
  • abortion
  • spontaneous
  • abortion
  • therapeutic
  • abortion
  • induced
  • reproductive Health

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Footnotes

  • Twitter @chanmichellec

  • Contributors Three authors (MCC, CRK and RKG) independently screened all the titles, abstracts and full texts identified from the initial search to determine eligibility for inclusion. Conflicts were resolved through discussion and consensus first between MCC and RKG and, if further discussion was needed, with the third reviewer CRK. Risk of bias was assessed by MCC and CRK.

  • Funding UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP)

  • Disclaimer The authors alone are responsible for the views expressed in this review article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

  • 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 Not commissioned; externally peer reviewed.

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