Does current guidance for the provision of prophylactic anti-D meet the requirement of D-negative women pre- and post-delivery?

Abstract

Abstract To reduce the risk of haemolytic disease of the fetus and newborn (HDFN) faced by D-positive fetuses that are carried by D-negative women, prophylactic anti-D (PAD) has been used during and after pregnancy. The administration of PAD has been carried out in accordance with the recommendations of national guidelines. To evaluate the adequacy of PAD provided to pregnant women, a PRISMA-P-based review was conducted to selectively analyse the literature published within the last ten years. Data extracted from 36 papers presented the quality of pre- and post-natal PAD provision to women in several countries, such as the UK, USA and Canada according to their reported low D-alloimmunisation rates. Countries, including Sweden and The Netherlands, have been using non-invasive prenatal testing (NIPT) to determine the fetal D-type. NIPT allows wiser utilisation of PAD treatment, while meeting the requirements of D-negative women. Other countries were identified to have areas for improvements in prenatal care and treatment. The improved outcome of reduced sensitisation (0.1%) seen with the Canadian alternative approach of two doses of 1500IU RAADP allowed a preliminary proposal for the best anti-D provision practice to be followed. The outcome also allowed the identification of factors influencing the treatment, including the number, volume and times of doses, along with medical resources and compliance. The review highlighted the need for a future randomised trial to expand knowledge and update the current guidelines. This trial should compare the available regimens of PAD administration while minimising the variation of the factors influencing the outcome.