Dear sir from what I understand from new NICE guide about miscarriage is that we don't give anti d for spontaneous complete miscarriage , is that correct?
Options for Questions 25-25
A Administer anti-D 250IU B Administer anti-D 500IU
C Administer anti-D 250IU plus Kleihauer test D Administer anti-D 500IU plus Kleihauer test
E Administer anti-D 500IU if Kleihauer test is positive F Administer routine antenatal prophylactic anti-D
G Measure anti-D antibody titre H Amniocentesis and measure OD450
I Fetal blood sampling J Elective delivery at 37-38 weeks
K Elective delivery at 34 weeks L Paternal Rhesus D zygosity
M Anti-D not needed N Fetal middle cerebral artery peak systolic velocity
Instructions:For each of the case histories described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
Question 25 A 40 year old woman is admitted at 16 weeks gestation with abdominal pain and vaginal bleeding. Half an hour later, she suffers a complete miscarriage. Investigations show that she is Rhesus negative with no red cell antibodies.
The answer to this was : give 500 anti d
Posted by Farrukh G.
• Spontaneous miscarriage: Anti-D Ig should be given to all non-sensitised RhD negative women who have a spontaneous complete or incomplete abortion after 12 weeks of pregnancy. Anti-D Ig should be given when there has been an intervention to evacuate the uterus. On the other hand, the risk of immunisation by spontaneous miscarriage before 12 weeks' gestation is negligible when there has been no instrumentation to evacuate the products of conception and anti-D Ig is not required in these circumstances
• Threatened miscarriage: Anti-D Ig should be given to all non-sensitised RhD negative women with a threatened miscarriage after 12 weeks of pregnancy. Where bleeding continues intermittently after 12 weeks' gestation, anti-D Ig should be given at 6-weekly intervals. Routine administration of anti-D Ig is not recommended before 12 weeks gestation. However it may be prudent to administer anti-D Ig where bleeding is heavy or repeated or where there is associated abdominal pain particularly if these events occur as gestation approaches 12 weeks
nice guide 2012
Posted by rania E.
thank you for your reply, but what i understood from new NICE is different
1.7 Anti-D rhesus prophylaxis
1.7.1 Offer anti-D rhesus prophylaxis at a dose of 250 IU (50 micrograms) to all
rhesus negative women who have a surgical procedure to manage an ectopic
pregnancy or a miscarriage.
1.7.2 Do not offer anti-D rhesus prophylaxis to women who:
receive solely medical management for an ectopic pregnancy or miscarriage or
have a threatened miscarriage or
have a complete miscarriage or
have a pregnancy of unknown location.
1.7.3 Do not use a Kleihauer test for quantifying feto–maternal haemorrhage.
