Quality statement 4: Anti-D immunoglobulin prophylaxis (up to and including 11+6 weeks of pregnancy)
Quality statement
Women, trans men and non-binary people who are rhesus D (RhD) negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy are not prescribed anti-D immunoglobulin prophylaxis. [2026]
Rationale
Anti-D immunoglobulin is used to prevent RhD sensitisation in people who are pregnant and RhD negative. However, there is no clear benefit in providing anti-D immunoglobulin prophylaxis to people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy.
Quality measures
The following measure can be used to assess the quality of care or service provision specified in the statement. It is an example of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of women, trans men and non-binary people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy who are prescribed anti-D immunoglobulin prophylaxis.
Numerator – the number in the denominator prescribed anti-D immunoglobulin prophylaxis.
Denominator – the number of women, trans men and non-binary people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy.
As the quality statement requires that anti‑D immunoglobulin prophylaxis is not prescribed to this population, the appropriate target achievement level is 0%
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (secondary care services) ensure that procedures and protocols are in place to ensure that anti-D immunoglobulin prophylaxis is not prescribed for people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy.
Healthcare professionals (such as maternity staff including midwives, consultant obstetricians and gynaecologists) do not prescribe anti-D immunoglobulin prophylaxis for people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy. If there is a discrepancy between length of gestation as measured from ultrasound and that calculated from last menstrual period, they use the findings from ultrasound to guide management.
Commissioners ensure that service providers do not prescribe anti-D immunoglobulin prophylaxis for people who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy.
People who are RhD negative with an ectopic pregnancy or miscarriage up to and including 11+6 weeks of pregnancy are not prescribed anti-D immunoglobulin prophylaxis as there is no clear benefit to them. If there is a difference between the number of weeks' pregnancy as measured from ultrasound and that calculated from their last menstrual period, their healthcare professional will use the findings from the ultrasound to guide the treatment they should receive.
Source guidance
Ectopic pregnancy and miscarriage: diagnosis and initial management. NICE guideline NG126 (2019, updated 2026), recommendation 1.18.1
Definitions of terms used in this quality statement
RhD negative
Blood is known as RhD positive when it has an inherited protein called the RhD antigen on the surface of the red blood cells, and as RhD negative when it does not. Around 15% of the UK population are RhD negative. RhD status is inherited and does not change over a person's lifetime. [Adapted from NICE's guideline on ectopic pregnancy and miscarriage, glossary and abbreviations and the NHS website]
Anti-D immunoglobulin prophylaxis and RhD sensitisation
Anti-D immunoglobulin prophylaxis neutralises any RhD positive antigens that can pass to the RhD negative person's blood from the RhD positive fetus. If the antigens have been neutralised, the pregnant person's blood won't produce these antibodies. Production of these antibodies is a process known as RhD sensitisation. Once sensitisation has occurred, the person's immune system is primed to recognise RhD positive red blood cells. On any future exposure, their body produces anti‑D antibodies rapidly. If they are carrying an RhD positive fetus, these antibodies can cross the placenta and attack the baby's red blood cells, leading to rhesus disease. [Adapted from NICE's full guideline on ectopic pregnancy and miscarriage, section 9]