Anti-D ( antiD ) in threatened miscarriage

NICE state with respect to use of Anti-D rhesus prophylaxis in ectopic pregnancy and miscarriage (1)

• do not offer anti-D immunoglobulin prophylaxis as a treatment for ectopic pregnancy or miscarriage to women, trans men and non-binary people for an ectopic pregnancy, miscarriage or threatened miscarriage up to and including 11+6 weeks' gestation
  • if there is a discrepancy between length of gestation as measured from ultrasound and that calculated from last menstrual period, use the findings from ultrasound to guide management
• offer anti-D immunoglobulin prophylaxis at a dose of at least 250 IU (50 micrograms) to women, trans men and non-binary people who are RhD-negative and are at 12+0 to 12+6 completed weeks of pregnancy and having medical management or a surgical procedure to manage ectopic pregnancy or miscarriage
• consider anti-D immunoglobulin prophylaxis at a dose of at least 250 IU (50 micrograms) for women, trans men and non-binary people who are RhD-negative and are at 12+0 to 12+6 completed weeks of pregnancy for threatened miscarriage with heavy or recurrent bleeding
• 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
• discuss the use of anti-D immunoglobulin with women, trans men and non-binary people if it is a suitable treatment option for them. Cover that:
  • it is a protein obtained from blood plasma, but
  • it does not contain blood cells (it is a filtered blood product)
• do not use a Kleihauer test for quantifying feto-maternal haemorrhage

NICE note that the recommendations “..represent a change in current practice. Anti-D immunoglobulin is no longer offered to women, trans men and non-binary people with an ectopic pregnancy or miscarriage at up to and including 11+6 weeks of pregnancy, including anyone having surgical procedures for management of the same. The change in recommendations also means that anti-D prophylaxis can be considered for women, trans men and non-binary people who experience a threatened miscarriage with heavy and recurrent bleeding between 12+0 and 12+6 weeks of pregnancy..”

Reference:

1. NICE (June 2026).Ectopic pregnancy and miscarriage: diagnosis and initial management