Preventing RhD haemolytic disease of the newborn

Give anti-rhesus (D) immunoglobulin to all pregnant women who are Rh negative

In 1994 we saw the 25th anniversary year of the worldwide introduction of anti-rhesus (D) immunoglobulin prophylaxis, one of the most successful prophylactic programmes in medical history. In 1977, 110 cases of stillbirth or neonatal death due to RhD haemolytic disease were registered in Britain; by 1992, this figure seemed to have dropped to nine cases.1 In this issue of the BMJ, however, Whitfield and colleagues show that this is a serious underestimation (p 1504).2 Extrapolation of their Scottish figures suggests that there are 50 deaths a year due to RhD haemolytic disease in Britain. They conclude that the discrepancy is due to underreporting because deaths due to early abortion (before 24 weeks) and late neonatal death (second to fourth week of life) are not included in official figures.

The policy introduced in 1969 was to give anti-D immunoglobulin to RhD negative women only after the birth of …