Obstet Gynecol Surv. 2025 May;80(5):315-324. doi: 10.1097/OGX.0000000000001391.
ABSTRACT
IMPORTANCE: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibodies to fetal red blood cells and is associated with significant fetal and neonatal morbidity and mortality. Rhesus D antigen (RhD)-mediated HDFN is the only preventable cause of alloimmunization in pregnancy. Widespread utilization of RhD prophylaxis reduces the risk of RhD-mediated alloimmunization from 17% to <1% in at-risk pregnancies, although RhD-mediated HDFN still occurs.
OBJECTIVE: To emphasize significance of RhD prophylaxis, outline current guideline-directed indications for administration, provide clarification in areas of uncertainty regarding prophylaxis administration, and review key concepts relevant to patient education and shared decision-making.
EVIDENCE ACQUISITION: PubMed and Google Scholar literature search.
RESULTS: Data over several decades have shown implementation of prenatal and postpartum RhD prophylaxis has significantly reduced incidence and morbidity of RhD-mediated HDFN. Most international guidelines recommend routine prophylaxis of Rh-negative mothers in the second trimester and peripartum, with additional prophylaxis following certain high-risk events. Recent shortages in RhD immunoglobulin (RhDIg) and new methods to determine fetal blood type have prompted renewed debate regarding criteria for prophylaxis during the first trimester.
CONCLUSION: Understanding indications for administration of RhD prophylaxis is essential for preventing RhD alloimmunization. Although uncertainty remains in some clinical scenarios, prophylaxis is strongly recommended in Rh-negative mothers in the second trimester, following events high-risk for sensitization in pregnancy, and postpartum.
RELEVANCE: In this review, the etiology of alloimmunization and indications for RhDIg prophylaxis, current society recommendations, and areas of debate are summarized and discussed.
PMID:40328690 | DOI:10.1097/OGX.0000000000001391
