title: Anti-D in Rh(D)-negative pregnant women: are at-risk pregnancies and deliveries receiving appropriate prophylaxis?
abstract: OBJECTIVE
  Although anti-D prophylaxis has greatly reduced the rate of Rh-immunization, there remain women who sensitize during or after pregnancy because of inadequate prophylaxis. The purpose of this study was to compare adherence to prophylaxis recommendations for antenatal and postnatal anti-D immunoglobulin administration.
  
  
  METHODS
  We conducted a retrospective cohort study of all pregnancies recorded at the Royal Victoria Hospital between 2001 and 2006 to determine the rates of antenatal and postnatal prophylaxis in Rh(D)-negative women. We compared adherence to anti-D prophylaxis recommendations between our institution's physician-dependent antenatal approach and the protocol-based postpartum approach. Logistic regression analysis was used to estimate the odds ratio and 95% confidence intervals of determinants of non-adherence to current recommendations for anti-D prophylaxis.
  
  
  RESULTS
  Antenatal administration was analyzed in 1868 pregnancies in eligible Rh-negative women. Among these women, 85.7% received appropriate antenatal prophylaxis and 98.5% of eligible women received appropriate postnatal prophylaxis. Factors independently associated with non-adherence to antepartum prophylaxis included first visit in the third trimester (P < 0.001), transfer from an outside hospital (P = 0.03), and physician licensing before 1980 (P = 0.04).
  
  
  CONCLUSIONS
  Unlike hospital-based protocol-dependent systems, physician-dependent systems for antenatal anti-D prophylaxis remain subject to errors of omission. A more standardized system is needed to ensure effective antenatal prophylaxis.
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Koby
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC.
authors.forename: Ami
authors.initials: A
authors.lastname: Grunbaum
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC.
authors.forename: Alice
authors.initials: A
authors.lastname: Benjamin
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC.
authors.forename: Robert
authors.initials: R
authors.lastname: Koby
authors.affiliation: Department of Obstetrics and Gynecology, Royal Victoria Hospital, McGill University, Montreal QC.
authors.forename: Haim A
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007518:Isoantibodies / Q000097:blood*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012204:Rh-Hr Blood-Group System / Q000276:immunology*; D018029:Rho(D) Immune Globulin / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D007518:Isoantibodies; C061961:RHO(D) antibody; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin