TY - JOUR T1 - Time to re-evaluate rhesus testing and anti-D prophylaxis in abortion care JF - BMJ Sexual & Reproductive Health JO - BMJ Sex Reprod Health DO - 10.1136/bmjsrh-2020-200815 SP - bmjsrh-2020-200815 AU - Jonathan Lord Y1 - 2020/11/05 UR - http://jfprhc.bmj.com/content/early/2020/11/05/bmjsrh-2020-200815.abstract N2 - 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.1Although 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:In this windowIn a new windowTable 1 Examples of national guidelines for recommended use of anti-D in the first trimesterThe 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.The main reason to continue as … ER -