Individual research recommendation details

Recommendation ID

NG140/3

Question

Should women having a surgical abortion up to and including 10⁺⁰ weeks' gestation have anti-D prophylaxis if they are RhD (or D) negative?

Any explanatory notes
(if applicable)

Why the committee made the recommendations

There was no evidence on anti-D prophylaxis for women having an abortion up to and including 13⁺⁶ weeks' gestation. There is also no international consensus on this, with significant variation between different international and national guidelines.

Current practice in the NHS is to give anti-D to all women who are having an abortion and are rhesus D negative. However, testing for rhesus status and then administering anti-D can result in significant delays for women. They may need to visit the service more than once to receive anti-D, and this can be a particular problem for women who are travelling a long way or who find it difficult to afford travel. The cost of testing for rhesus status and giving anti-D also needs to be considered.

With these points in mind, the committee made recommendations based on their knowledge and experience. They agreed that, for women up to and including 10⁺⁰ weeks' gestation, the volume of fetal blood cells transmitted to the mother is unlikely to cause maternal sensitisation. The impact of delays to the abortion, travel problems, and costs to services are likely to outweigh any benefit prophylaxis provides. The NICE guideline on ectopic pregnancy and miscarriage recommends against anti-D prophylaxis for women having medical management for these conditions. The committee agreed that the risks and benefits of anti-D prophylaxis would be similar for women having a medical abortion. Therefore, the committee made a recommendation in line with the NICE guideline on ectopic pregnancy and miscarriage.

Although there is no evidence to distinguish surgical and medical abortion on this topic, the committee agreed there may be risk of more fetal blood cell transmission during a surgical abortion. Because of this, anti-D prophylaxis may be beneficial for women having a surgical abortion up to and including 10⁺⁰ weeks' gestation.

In the independent sector, point-of-care testing is used and anti-D is provided immediately. In contrast, NHS transfusion laboratories usually follow the same processes for managing anti-D as they do for managing whole transfusion systems. This is unnecessary and introduces delays, and means that women must choose between not having testing and prophylaxis or returning to the service after the abortion. To help reduce delays, the committee made a recommendation in line with current practice in the independent sector.

In the absence of evidence, the precise benefits and risks of anti-D prophylaxis are unclear. The uncertainty is highest for women having a surgical abortion up to and including 10⁺⁰ weeks' gestation, so the committee made a research recommendation covering this group.

How the recommendations might affect practice

Restricting anti-D prophylaxis to women who are most likely to benefit from it could potentially produce cost savings of over £1 million annually across the NHS. Staff will be freed up to focus on more important and beneficial areas of the abortion service.

NHS Trusts and transfusion laboratories may need to amend their systems and processes to ensure they can provide rhesus status testing and anti-D prophylaxis without introducing delays to the abortion process.

Full details of the evidence and the committee's discussion are in evidence review C: anti-D prophylaxis for women up to 13⁺⁶ weeks' gestation.

Source guidance details

Comes from guidance

Abortion care

Number

NG140

Date issued

September 2019

Other details