Antenatal Prophylaxis of RH Iso-Immunization with Anti-D Immunoglobulin: Effectiveness and risks

Abstract

Introduction: routine after delivery administration of immunoglobulin (Ig) anti-D, as well as its administration in risk events for transplacental bleeding, decreased the incidence of Rh isoimmunization of 17% to 0,83-1,5%.To minimize this risk it is now suggested its routine administration at antenatal period. Since this is derived from blood, it is necessary to consider the risks involved in its administration. Objectives: to review the available evidence on the Effectiveness and Risks of the routine anti-D Ig administration during pregnancy for prophylaxis of Rh Isoimmunization. Methods: search for articles from systematic review, meta-analyses, clinical trials, randomized controlled clinical studies and practice guidelines in Medline, MEB sites and index of RMP, published in Portuguese, English and Spanish, in the last 10 years. Conclusions: antenatal prophylaxis with Anti-D Ig (1.500 UI at 28 weeks or 500 UI at 28 and 34 weeks of gestation) is effective in preventing Rh Isoimmunization (SORT C).The doses used are insufficient to cause anaemia or clinical hemolysis in newborns and the risk of transmission of infectious diseases is low (SORT C). It would be advisable to do new studies with patient focused end-point to evaluate the impact of this measure on fetus/newborn mortality and morbidity.