Universalized, evidence-based guidelines regarding immunoglobulin G anti-D prophylaxis (RhIG) among Rhesus (D)-negative women undergoing abortions in the first trimester should be developed and closely adhered to, according to a study recently published in the International Journal of Gynecology & Obstetrics.
This issue is particularly pertinent in the hemolytic disease of the fetus and newborn (HDFN).
There is evidence that abortions performed in the first trimester are a relatively safe procedure. These are typically carried out with the administration of mifepristone and misoprostol or vacuum aspiration.
There remains some controversy regarding the value of Rhesus testing in medical abortions as clinicians weigh up the benefits versus the risks. Evidence in this area is constantly evolving, and clinicians must remain up to date regarding the latest best practice protocols.
Read more about HDFN testing and diagnosis
Researchers sought to gather evidence regarding current guidelines regarding the merits of Rhesus testing and anti-D prophylaxis among women undergoing abortions in the first trimester. A search of available articles on this subject yielded 44 studies that were included in the final analysis.
These 44 studies had numerous recommendations regarding Rhesus D practices in the context of pregnancy termination. While some recommended Rhesus D testing during the first trimester, others recommended testing only after the abortion had been performed. Another frequent guideline is to conduct testing after more than 12 weeks of amenorrhea (ie, the absence of menstruation).
There are a number of arguments for and against immunoglobulin G anti-D administration in abortions performed in the first trimester. Arguments in favor include the reduction of Rhesus D alloimmunization and the prevention of HDFN in subsequent pregnancies. Arguments against this approach include the lack of evidence regarding its benefits at low gestational ages and the negligible risk of Rhesus alloimmunization during voluntary pregnancy termination in the first trimester.
“The comprehensive analysis of RhD practices reveals significant differences in evidence-based guidelines worldwide,” the authors of the study wrote. “Standardizing protocols globally while accommodating local contexts and individual patient needs is paramount.”
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