Use of anti-D immunoglobulin in the treatment of threatened miscarriage in the accident and emergency department.
BACKGROUND
The UK guidelines for the use of anti-D immunoglobulin for rhesus prophylaxis have been revised. Anti-D immunoglobulin is no longer recommended for Rh D negative women after a threatened miscarriage less than 12 weeks gestation. These patients are at risk of rhesus immunisation, and there should be a policy for their treatment in the accident and emergency (A&E) department.


METHODS
A retrospective study over a 17 month period was conducted looking at women less than 12 weeks gestation who presented to an A&E department with a threatened miscarriage.


OBJECTIVE
To determine how many of these patients presented with heavy or repeated bleeding, or abdominal pain, and whether the guidelines for the use of rhesus prophylaxis were followed.


RESULTS
112 women fulfilled the criteria for inclusion. Nineteen patients were Rh D negative. Eighty three patients (74.1%) presented with either abdominal pain or heavy or recurrent bleeding. Rhesus status was recorded in the A&E notes in only 15 patients (13.3%). Ninety seven patients (86.6 %) were discharged without rhesus status being checked. Fifteen Rh D negative patients were discharged without being offered anti-D immunoglobulin.


CONCLUSIONS
Many women who present to the A&E department with a threatened miscarriage of less than 12 weeks gestation have heavy or recurrent bleeding or associated abdominal pain. These patients have an increased risk of fetomaternal haemorrhage and the consequent development of haemolytic disease of the newborn is possible. It should be mandatory for the A&E department to record rhesus status. In the context of A&E medicine, anti-D immunoglobulin should still be offered to all non-immune Rh D negative women presenting with a threatened miscarriage less than 12 weeks gestation.
Weinberg
L
L
Accident and Emergency Department, Royal Cornwall Hospital, Truro, UK. weinberg14@aol.com
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000033:Abortion, Threatened / Q000150:complications / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D004739:England; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000517:prevention & control; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy
D018029:Rho(D) Immune Globulin