For Rh D negative women with an Rh D positive fetus OR fetal Rh D status unknown Who do not have immune Anti-D (no evidence of anti-D in antibody screen ) Regardless of whether they have had any previous doses of Anti-D Ig Steps 1. Take sample for Group & Antibodies 2. Request 1500iu Anti-D Ig 3. Confirm product/dose/expiry/patient identity before administration 4. Administer anti-D Ig as soon as possible and within 72 hours of presentation (give regardless of whether patient has had routine 28 week injection) 5. If >20/40 request a Kleihauer to estimate feto-maternal haemorrhage. Do not wait for Kleihauer result before giving 1500iuAnti-D Ig. An FMH of <2mls means additional anti-D Ig is not required. 6. Check Kleihauer and give additional anti-D Ig as advised by the laboratory Indications (all gestations) Ectopic Pregnancy * see note below Chorionic villous sampling Surgical management of miscarriage/evacuation Amniocentesis of retained products Cordocentesis Molar Pregnancy Fall/abdominal trauma Termination of pregnancy (TOP)–medical ≥7/40# In-utero intervention note below External Cephalic Version ALL surgical TOP Intra-uterine death at both diagnosis AND delivery PV bleeding < 12 weeks Spontaneous complete miscarriage Anti-D Ig not required without surgical management OR minor, painless bleeding with viable pregnancy PV bleeding with heavy bleeding and pain PV bleeding after 12-20/40 Any PV bleeding or Miscarriage after 12/40
Follow steps 1-4 above
12-20/40 :follow 1-4 above
>20/40: follow 1-6 above
Recurrent or Continuous PV bleeding: Where it is clinically judged to be the same sensitising event with no features suggestive of a new presentation or a significant change in the pattern or severity of bleeding, such as the presence of abdominal pain. 12-20/40 Follow steps 1-4 at 6 weekly intervals for duration of bleeding 20-40/40 Follow steps 1-4 at 6 weekly intervals Follow steps 5-6 at 2 weekly intervals for duration of bleeding Anti-D Ig prophylaxis following intrauterine Death (IUD) In addition to anti-D Ig prophylaxis administered at diagnosis of IUD, a further dose of anti-D should be given after delivery, as there could be variable/significant delay between diagnosis & delivery.