title: Report of the first nationally implemented clinical routine screening for fetal RHD in D- pregnant women to ascertain the requirement for antenatal RhD prophylaxis.
abstract: BACKGROUND
  A combination of antenatal and postnatal RhD prophylaxis is more effective in reducing D immunization in pregnancy than postnatal RhD prophylaxis alone. Based on the result from antenatal screening for the fetal RHD gene, antenatal RhD prophylaxis in Denmark is given only to those D- women who carry a D+ fetus. We present an evaluation of the first national clinical application of antenatal RHD screening.
  
  
  METHODS
  In each of the five Danish health care regions, blood samples were drawn from D- women in Gestational Week 25. DNA was extracted from the maternal plasma and analyzed for the presence of the RHD gene by real-time polymerase chain reaction targeting two RHD exons. Prediction of the fetal RhD type was compared with serologic typing of the newborn in 2312 pregnancies, which represented the first 6 months of routine analysis.
  
  
  RESULTS
  For the detection of fetal RHD, the sensitivity was 99.9%. The accuracy was 96.5%. The recommendation for unnecessary antenatal RhD prophylaxis for women carrying a D- fetus was correctly avoided in 862 cases (37.3%), while 39 women (1.7%) were recommended for antenatal RhD prophylaxis unnecessarily. Two RHD+ fetuses (0.087%) were not detected, and antenatal RhIG was not given.
  
  
  CONCLUSIONS
  These data represent the first demonstration of the reliability of routine antenatal fetal RHD screening in D-, pregnant women to ascertain the requirement for antenatal RhD prophylaxis. Our findings should encourage the implementation of such screening programs worldwide, to reduce the unnecessary use of RhIG.
authors: Department of Clinical Immunology, Section 2034, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. frederik.banch.clausen@rh.regionh.dk
authors: Frederik Banch
authors: FB
authors: Clausen
authors: Mette
authors: M
authors: Christiansen
authors: Rudi
authors: R
authors: Steffensen
authors: Steffen
authors: S
authors: Jørgensen
authors: Christian
authors: C
authors: Nielsen
authors: Marianne Antonius
authors: MA
authors: Jakobsen
authors: Rikke Dyhrberg
authors: RD
authors: Madsen
authors: Karina
authors: K
authors: Jensen
authors: Grethe Risum
authors: GR
authors: Krog
authors: Klaus
authors: K
authors: Rieneck
authors: Ulrik
authors: U
authors: Sprogøe
authors: Keld Mikkelsen
authors: KM
authors: Homburg
authors: Niels
authors: N
authors: Grunnet
authors: Morten Hanefeld
authors: MH
authors: Dziegiel
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis; D060888:Real-Time Polymerase Chain Reaction; D012203:Rh Isoimmunization / Q000517:prevention & control*; D012204:Rh-Hr Blood-Group System / Q000235:genetics*
chemical_list: D012204:Rh-Hr Blood-Group System; C026410:Rho(D) antigen