Prevention and management of RhD alloimmunisation in pregnancy

Rhesus D alloimmunisation remains a major problem despite the use of anti-D prophylaxis. Immunisation during pregnancy commonly occurs in the absence of any overt sensitizing event. Appropriate and timely intervention can significantly reduce the rate of immunisation (17% - 1%). In this respect, a simple algorhythm for the management of RhD negative women in pregnancy is presented. Traditionally, identifying and monitoring fetuses at risk of anaemia in RhD alloimmunised pregnancies required invasive testing such as serial amniocentesis. This procedure is associated with significant complications. Recent evidence favours a non-invasive approach by measuring the peak systolic velocity in the fetal middle cerebral artery. This Doppler method has the same accuracy in predicting fetuses at risk of anaemia when compared with amniocentesis, but without its complications. We therefore present new guidelines for the monitoring of RhD alloimmunised pregnancies. Obstetrics & Gynaecology Forum Vol. 15 (3) 2005: 27-3