Prophylactic use of Rh D immunoglobulin in pregnancy care

The National Blood Authority (NBA) released the Guidelines on the Prophylactic Use of Rh D Immunoglobulin (Anti-D) in Obstetrics in 2003, with the aim of providing clinical guidance on antenatal prophylaxis. These guidelines also addressed supply constraints at the time of publication by including a staged implementation process for a full antenatal prophylaxis program in Australia.

In 2016, the NBA and Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) agreed on the need to update the clinical guidance on the prophylactic use of Rh D immunoglobulin while maintaining the policy intent for an antenatal prophylaxis program. 

The development of the Guideline for the prophylactic use of Rh D immunoglobulin in pregnancy care (2.63 MB) (the Guideline) was a joint project between RANZCOG and the NBA. Representatives from RANZCOG were joined by other experts from a range of clinical settings on the Expert Reference Group to develop the Guideline. The NBA gratefully acknowledges the dedication and expertise provided by the Expert Reference Group.

The Guideline is intended to provide updated clinical guidance on the prophylactic use of Rh D immunoglobulin in pregnancy care and is targeted at health care professionals involved in the management of pregnant Rh D negative women. 

The Guideline was published on 28 May 2021 in electronic format. 

The Guideline introduces new clinical guidance on the use of non-invasive prenatal testing (NIPT) to determine fetal RHD status. This guidance is based on scientific evidence and consensus among clinical experts and is not a policy statement on funding and supply arrangements for the national provisions of NIPT. The existing supply arrangements and status of the application for new MBS items for the national provision of NIPT to determine fetal RHD status are not addressed specifically in this Guideline.

The Guideline and accompanying resources can be accessed by clicking on the links below. 

Guideline 

Guideline for the prophylactic use of Rh D immunoglobulin in pregnancy care (pdf) (2.63 MB)

 

Technical report on the methodology and findings of the evidence review process

Volume 1 of the technical report contains background information and the results of the  systematic reviews pertaining to the clinical questions posed within the Guideline (pdf) (2.52 MB)

 

 

Volume 2 of the technical report contains appendices that document the literature searches and critical appraisal of the studies (pdf) (3.94 MB)

Reference materials

Diagram of Care pathway for the prophylactic use of Rh D immunoglobulin in pregnancy care  Care pathway for the prophylactic use of Rh D immunoglobulin in pregnancy care (including non-invasive prenatal testing) (pdf (132.01 KB) | vsd (172 KB))

 

Diagram of Care pathway for the prophylactic use of Rh D immunoglobulin in pregnancy care excluding NIPT Care pathway for the prophylactic use of Rh D immunoglobulin in pregnancy care (excluding non-invasive prenatal testing) (pdf (122.68 KB) | vsd (163.5 KB))

Summary of clinical guidance, comprising

- Recommendations and expert opinion points

- Use and timing of pathology testing

- Indications and timing for the administration of Rh D immunoglobulin 

(pdf (264.61 KB) | docx (43.59 KB))

Maintenance of the Guideline

The evidence base underpinning the Guideline will be updated in the second half of 2021 to confirm the accuracy and relevance of the clinical guidance. While the identification of new studies conflicting with the existing guidance is not expected, updated literature searches will capture any new studies published since the original searches were conducted in 2018. If any changes to the evidence base are identified, the NBA will collaborate with the Expert Reference Group to determine the impact on the current guidance.

Complementary educational resources

The NBA is currently planning activities to facilitate uptake and implementation of the Guideline. Plans are already underway to develop a complementary educational resource under the BloodSafe eLearning program. Further details will be provided here as work progresses.