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Foregoing Rh testing and anti-D immunoglobulin for women presenting for early abortion: a recommendation from the National Abortion Federation's Clinical Policies Committee

      Early abortion continues to expand outside of traditional clinics, through telemedicine, self-managed medication abortion, or in smaller offices that do not specialize in obstetrical care. Consequently, requiring Rh testing and anti-D immunoglobulin as part of abortion care is becoming a barrier. As of early 2019, the Society of Family Planning [
      • Medical management of first-trimester abortion
      ], the American College of Obstetricians and Gynecologists [
      • Committee on Practice Bulletins-Obstetrics
      Practice bulletin no. 181: prevention of Rh D alloimmunization.
      ], and the Society of Obstetricians and Gynecologists of Canada [
      • Fung K.F.K.
      • Eason E.
      No. 133-prevention of Rh alloimmunization.
      ] recommend that all Rh D-negative women receive anti-D immunoglobulin after an induced abortion, regardless of gestational age or type of procedure. However, the evidence of clear benefit in early pregnancy, the gestational age at which sensitization might occur, and the differences between aspiration, sharp curettage, or medication abortion, are not well established [
      • Karanth L.
      • Jaafar S.H.
      • Kanagasabai S.
      • Nair N.S.
      • Barua A.
      Anti-D administration after spontaneous miscarriage for preventing rhesus alloimmunisation.
      ]. Indeed, other guidelines vary. The World Health Organization recommends that where Rh D-negative status is prevalent and anti-D immunoglobulin is routinely provided, it should be administered. However, Rh testing is not a requirement for abortion in any setting [
      • World Health Organization
      Safe abortion: Technical and policy guidance for health systems.
      ]. Dutch guidelines do not recommend testing and treating Rh D-negative women until the pregnancy is greater than 49 days from the last menstrual period [
      • Dutch Association of Abortion Specialists (NgvA)
      Guideline for the treatment of women undergoing termination of pregnancy.
      ]. The British Committee for Standards in Hematology recommends no treatment for spontaneous complete miscarriage below 12 weeks but treatment for therapeutic termination of pregnancy regardless of gestational age [
      • Qureshi H.
      • Massey E.
      • Kirwan D.
      • Davies T.
      • Robson S.
      • White J.
      • et al.
      BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn.
      ]. Danish guidelines state that routine anti-D immunoglobulin treatment does not appear to be necessary for pregnancies of less than 8 weeks gestation [
      • Danks Selskab for Obstetrik og Gynaekologi
      Kirurgisk provokeret abort i første trimester.
      ]. In 1997, the Swedish Board of Health and Welfare recommended against the use of anti-D immunoglobulin in early spontaneous or medication abortion [
      • Fiala C.
      • Fux M.
      • Gemzell Danielsson K.
      Rh-prophylaxis in early abortion.
      ].
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