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Recommendations for RhD testing and administration of anti-D immune globulin for patients undergoing pregnancy termination[1-6]

Recommendations for RhD testing and administration of anti-D immune globulin for patients undergoing pregnancy termination[1-6]
Organization (year) Gestational age to initiate Rh testing and administer anti-D immune globulin in D-negative patients Notes
SFP (2022) ≥12 weeks
  • Shared decision-making should be used, and some patients may request testing/administration at earlier gestational ages or decline testing/administration altogether.
  • When anti-D immune globulin is given, the following doses are recommended:
    • ≤12 weeks (ie, patient preference, sharp curettage*): 50 mcg
    • 13 to 18 weeks: 100 mcg
    • ≥19 weeks: 300 mcg
NAF (2022) ≥12 weeks
  • For patients <12 weeks, patients and providers may forgo RhD testing and anti-D immune globulin for those who are RhD negative.
WHO (2022) ≥12 weeks
  • Determination of RhD status and administration of anti-D prophylaxis are not considered prerequisites for pregnancy termination at gestational ages <12 weeks.
ACOG (2024) ≥12 weeks
  • For patients <12 weeks, RhD testing (with administration of anti-D immune globulin in RhD negative patients) can be considered on an individual basis in the context of shared decision-making.
  • When anti-D immune globulin is given, the following doses are typically given:
    • <12 weeks: 50 mcg
    • ≥12 weeks: 300 mcg
SOGC (2024) ≥12 weeks
  • For patients ≥8 but <12 weeks, RhD testing (with administration of anti-D immune globulin in RhD negative patients) can be considered based on individual basis.
SMFM (2024) All gestations
  • This recommendation is for individuals in care settings where RhD testing and anti-D immune globulin administration are logistically and financially feasible and do not hinder access to abortion care.

ACOG: American College of Obstetricians and Gynecologists; NAF: National Abortion Federation; SFP: Society of Family Planning; SMFM: Society for Maternal-Fetal Medicine; SOGC: Society of Obstetricians and Gynecologists of Canada; WHO: World Health Organization.

* Uterine aspiration rather than sharp curettage is the standard surgical method of termination of pregnancy; it is unclear how sharp curettage impacts the need for anti-D immune globulin.
References:
  1. Horvath S, Goyal V, Traxler S, Prager S. Society of Family Planning committee consensus on Rh testing in early pregnancy. Contraception 2022; 114:1.
  2. 2022 Clinical Policy Guidelines for Abortion Care. National Abortion Federation. Available at: https://prochoice.org/providers/quality-standards/ (Accessed on November 3, 2022).
  3. Abortion Care Guideline (2022). World Health Organization. Available at: https://www.who.int/publications/i/item/9789240039483 (Accessed on November 3, 2022).
  4. Rh Dimmune globulin administration after abortion or pregnancy loss at less than 12 weeks of gestation. Clinical Practice Update. American College of Obstetricians and Gynecologists. Obstet Gynecol 2024.
  5. Fung-Kee-Fung K, Wong K, Walsh J, et al. Guideline No. 448: Prevention of Rh D Alloimmunization. J Obstet Gynaecol Can 2024; 46:102449.
  6. Society for Maternal-Fetal Medicine (SMFM), Prabhu M, Louis JM, et al. Society for Maternal-Fetal Medicine Statement: RhD immune globulin after spontaneous or induced abortion less than 12 weeks of gestation. Am J Obstet Gynecol 2024.
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