The French College of Obstetricians and Gynecologists (CNGOF) has issued new recommendations for the prevention of hemolytic disease of the fetus and newborn (HDFN) during the first trimester.
These guidelines were recently published in the International Journal of Gynecology and Obstetrics.
The previous CNGOF guidelines on HDFN prevention were released in 2005. Given significant advancements in the field over the past two decades, the society decided to update its recommendations using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.
This system is widely used to evaluate the quality of evidence and the strength of clinical recommendations. In this case, the recommendations were reviewed by a panel of experts over two rounds of assessment.
No RhIG before 12 weeks
The panel recommends against administering Rh immunoglobulin (RhIG) before 12 weeks of gestation in pregnancies where the mother is RhD-negative and the father is RhD-positive or of unknown status. While fetuses in such cases may be RhD-positive and thus at risk of HDFN, current evidence does not support the effectiveness of RhIG in preventing immunization or miscarriage before the 12th week of gestation.
RhIG is also not indicated before 12 weeks of gestation in RhD-negative pregnancies, even in the event of bleeding. Although bleeding has traditionally been considered a risk factor for immunization, recent studies reviewed by the panel did not confirm this association.
Benefit of RhIG in ectopic pregnancies remains uncertain
In cases of ectopic pregnancy where the mother is RhD-negative and the father is RhD-positive or of unknown status, the benefit of RhIG administration during the first trimester remains uncertain due to a lack of evidence.
It is important to note that the expert panel deemed the overall quality of available data as low and are therefore, classified as weak recommendations, meaning that clinical judgment and individual patient factors should guide decision-making.
“Although the quality of evidence from the literature is very low, it is recommended that RhD immune globulin not be administered in cases of induced or spontaneous abortion or bleeding before 12 weeks of gestation to reduce the risk of alloimmunization,” the authors wrote.
