Anti-D ( antiD ) in threatened miscarriage

• Anti-D Ig is no longer necessary in women with threatened miscarriage with a viable fetus and cessation of bleeding before 12 weeks' gestation (1)
  • "..evidence that women are sensitised after uterine bleeding in the first 12 weeks of pregnancy where the fetus is viable and the pregnancy continues is scant though there are very rare examples.. Against this background, routine administration of anti-D Ig cannot be recommended. However it may be prudent to administer anti-D Ig where bleeding is heavy or repeated or where there is associated abdominal pain particularly if these events occur as gestation approaches 12 weeks. The period of gestation should be confirmed by ultrasound..."

NICE state with respect to use of Anti-D rhesus prophylaxis in ectopic pregnancy and miscarriage (2)

• offer anti-D rhesus prophylaxis at a dose of 250 IU (50 micrograms) to all rhesus negative women who have a surgical procedure to manage an ectopic pregnancy or a miscarriage
• do not offer anti-D rhesus prophylaxis to women who:
  • receive solely medical management for an ectopic pregnancy or miscarriage or
  • have a threatened miscarriage or
  • have a complete miscarriage or
  • have a pregnancy of unknown location
• do not use a Kleihauer test for quantifying feto-maternal haemorrhage

Reference:

1. Royal College of Obstetricians and Gynaecologists. Clinical Green Top Guidelines (22) - Use of Anti-D Immunoglobulin for Rh Prophylaxis - Revised May 2002.
2. NICE (September 2023).Ectopic pregnancy and miscarriage: diagnosis and initial management