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
- 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 [
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.