Do not offer anti-D immunoglobulin prophylaxis as a treatment for ectopic pregnancy or miscarriage to women, trans men and non-binary people for an ectopic pregnancy, miscarriage or threatened miscarriage up to and including 11+6 weeks' gestation. If there is a discrepancy between length of gestation as measured from ultrasound and that calculated from last menstrual period, use the findings from ultrasound to guide management. [2026]
Offer anti-D immunoglobulin prophylaxis at a dose of at least 250 IU (50 micrograms) to women, trans men and non-binary people who are RhD-negative and are at 12+0 to 12+6 completed weeks of pregnancy and having medical management or a surgical procedure to manage ectopic pregnancy or miscarriage. [2026]
Consider anti-D immunoglobulin prophylaxis at a dose of at least 250 IU (50 micrograms) for women, trans men and non-binary people who are RhD-negative and are at 12+0 to 12+6 completed weeks of pregnancy for threatened miscarriage with heavy or recurrent bleeding. [2026]
Discuss the use of anti-D immunoglobulin with women, trans men and non-binary people if it is a suitable treatment option for them. Cover that:
it is a protein obtained from blood plasma, but
it does not contain blood cells (it is a filtered blood product). [2026]
Do not use a Kleihauer test for quantifying feto-maternal haemorrhage. [2012]
The committee agreed that there was a lack of recently published evidence on the efficacy and safety of the use of anti-D immunoglobulin prophylaxis. The committee took into account expert testimony about the use of anti-D immunoglobulin prophylaxis, and the incidence of sensitising events in people who are RhD-negative.
The committee noted that there is a lack of evidence to suggest a benefit of providing anti-D immunoglobulin prophylaxis under 12 weeks, and no evidence to suggest that there was a difference in sensitisation rates between medical and surgical interventions for ectopic pregnancy or miscarriage. The committee also took into account supporting evidence that showed, where sensitising events occurred, high levels of maternofetal red blood cells were recorded before the event. It was also noted that sensitising events did not just occur as a result of the D antigen, but can be caused by other antigens such as C and E antigens.
The committee also agreed that it was important to calculate gestation based on ultrasound findings, as this is more accurate than using last menstrual period.
Taking all this into account, the committee agreed to make population-specific recommendations based on the balance of benefits and harms for each group. The committee discussed that, for people who are 12+0 to 12+6 weeks of pregnancy who are having medical management or a surgical procedure to manage ectopic pregnancy or miscarriage, anti-D should be offered. This is unchanged from the previous recommendation, and is because of the increased risk of sensitisation after the first trimester (12+0 weeks). A recommendation to consider anti-D was made for people who are 12+0 to 12+6 weeks of pregnancy and experiencing threatened miscarriage with heavy or recurrent bleeding, because it is uncertain as to whether there is a link between heavy or recurrent bleeding and sensitisation. The committee chose not to define heavy or recurrent bleeding, and discussed that this should be based on clinical judgement.
The committee discussed that the dose of 250 IU given in the original recommendations is a dose size that is not always available in NHS settings, but wanted to be clear that 250 IU is the minimum dose that should be used and that larger doses can be used if that is all that is available. The committee also agreed that where anti-D immunoglobulin is a suitable treatment for women, trans men and non-binary people experiencing an ectopic pregnancy or miscarriage, they should be made aware that it is a blood product so they can make an informed choice about its use. The committee discussed the importance of ensuring this discussion takes place, as people may not want to receive blood products for personal reasons.
Full details of the evidence and the committee's discussion are in evidence review E: anti-D immunoglobulin prophylaxis.
The recommendations represent a change in current practice. Anti-D immunoglobulin is no longer offered to women, trans men and non-binary people with an ectopic pregnancy or miscarriage at up to and including 11+6 weeks of pregnancy, including anyone having surgical procedures for management of the same. The change in recommendations also means that anti-D prophylaxis can be considered for women, trans men and non-binary people who experience a threatened miscarriage with heavy and recurrent bleeding between 12+0 and 12+6 weeks of pregnancy.
Overall, there is expected to be a reduction in costs as fewer people will be offered anti-D immunoglobulin. The recommendations may also remove barriers from early pregnancy services being provided in community locations, such as being incorporated within a woman's health hub.