Letters

Preventing RhD haemolytic disease of the newborn

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1164b (Published 11 April 1998) Cite this as: BMJ 1998;316:1164

RhD negative women who have intrauterine death may need anti-D immunoglobulin

  1. Robert Fox, Consultant obstetrician
  1. Taunton and Somerset Hospital, Taunton TA1 5DA
  2. Department of Obstetrics and Gynaecology, Women's Hospital, Liverpool L8 7SS
  3. National Blood Service, Mersey and North Wales Centre, Liverpool L7 8TW
  4. Department of Biological Sciences, University of Liverpool, PO Box 147, Liverpool L69 3BX
  5. North East Lincolnshire NHS Trust, Grimsby DN33 2BA
  6. Alton Health Centre, Alton, Hampshire GU34 2QX
  7. Royal College of Obstetricians and Gynaecologists Audit Unit, St Mary's Hospital, Manchester M13 0JH

    EDITOR—Mayne et al reported evidence of benefit from routine antenatal administration of anti-D immunoglobulin to primigravid women who are RhD negative.1 It has been proposed that this policy be adopted nationwide. I would like to suggest another modification to the current guidelines for RhD negative women who experience an intrauterine death.

    Isoimmunisation is a maternal immune response to the passage of fetal red cells into the maternal circulation. This occurs spontaneously in the antenatal period. Many antenatal transplacental haemorrhages pass unrecognised clinically, but large transplacental haemorrhage may cause fetal death.2 Even large fetal bleeds are generally pain free, and the woman usually presents with absence of fetal movement alone, the diagnosis not becoming apparent until the result of a Kleihauer test (for fetal cells in the maternal circulation) is known.

    Currently, there is no specific advice for the care of RhD negative women with an intrauterine death,3 and many if not all maternity units seem to manage them identically to RhD negative women in normal labour; anti-D immunoglobulin is given after delivery (within 72 hours for optimal effect). Women with an intrauterine death often present 24 hours or more after fetal movement has stopped, and the fetus may not be delivered for 48 hours, particularly as the mother often returns home before induction of labour. Given this, the delivery may not take place until more than 72 hours after any lethal transplacental haemorrhage. It seems logical, therefore, that all non-sensitised RhD negative women presenting with an intrauterine …

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