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 [
[1]
], the American College of Obstetricians and Gynecologists [
[2]
], and the Society of Obstetricians and Gynecologists of Canada [
[3]
] 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 [
[4]
]. 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 [
- Karanth L.
- Jaafar S.H.
- Kanagasabai S.
- Nair N.S.
- Barua A.
Anti-D administration after spontaneous miscarriage for preventing rhesus alloimmunisation.
Cochrane Database Syst Rev. 2013; CD009617https://doi.org/10.1002/14651858.CD009617.pub2
[5]
]. 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 [
[6]
]. 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 [
- Dutch Association of Abortion Specialists (NgvA)
Guideline for the treatment of women undergoing termination of pregnancy.
https://www.bloemenhove.nl/en/professionals/quality/guidelines;
Date: 2011
Date accessed: January 15, 2019
[7]
]. Danish guidelines state that routine anti-D immunoglobulin treatment does not appear
to be necessary for pregnancies of less than 8 weeks gestation [
[8]
]. In 1997, the Swedish Board of Health and Welfare recommended against the use of
anti-D immunoglobulin in early spontaneous or medication abortion [
[9]
].To read this article in full you will need to make a payment
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References
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Published online: March 10, 2019
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