CTF Summary Table: D(Rh) Sensitization

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Screening for D (Rh) Sensitization in Pregnancy

Adapted by Marie-Dominique Beaulieu, MD, MSc, FCFP, Department of Family Medicine, University of Montreal, from a report prepared for the US Preventive Services Task Force by Carolyn DiGuiseppi, MD, MPH

These recommendations were finalized by the Task Force in June 1993

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

ABO and D (formerly Rh) blood group antibody screening at the first prenatal visit and repeat antibody screening within 72 hours of delivery of a D positive infant. Intervention Administration of 300 ľg of (D) immunoglobulin (D Ig) IM to unsensitized D negative women within 72 hours of delivery of a D positive newborn prevents sensitization from up to 15 mL of D positive red blood cells. Randomized controlled trials <1,2> (I) There is good evidence to support the recommendation for prenatal and antenatal antibody screening. (A)

Repeat antibody screening test between the 24-28 weeks of gestation if the mother is negative. Prophylactic administration of 300 ľg of D Ig at 28-29 weeks gestation to unsensitized women further reduces the risks of sensitization. Non-randomized controlled trials <3-5> (II-1) There is fair evidence to support the recommendation that additional screening be performed at 24-28 weeks gestation. (B)

Repeat antibody screening before induced abortion, amniocentesis and other obstetrical complications or procedures in which there is the possibility of fetal bleed. Prophylactic administration of 300 ľg D Ig after induced abortion or amniocentesis (50 ľg if 13 weeks or less) reduces the incidence of sensitization. Induced abortion: Case series <8,9> (III)
Amniocentesis: Non-randomized controlled trial <7> (II-1)
There is fair evidence to support the recommendation that screening be performed with induced abortion and amniocentesis. (B)

Similar rates of sensitization were found in both intervention and control groups after chorionic villus sampling. Chorionic Villus Sampling (CVS): Randomized controlled trial <10> (I) There is poor evidence regarding the inclusion or exclusion of screening with CVS. (C)

No direct evidence for or against use of D Ig with other obstetric procedures and complications although it may be prudent to administer where the possibility of fetal to maternal bleed is anticipated. Expert opinion <6,12> (III) There is poor evidence regarding the inclusion or exclusion of screening for other obstetrical complications, procedures or outcomes. (C)

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
ABO and D (formerly Rh) blood group antibody screening at the first prenatal visit and repeat antibody screening within 72 hours of delivery of a D positive infant.	Intervention Administration of 300 ľg of (D) immunoglobulin (D Ig) IM to unsensitized D negative women within 72 hours of delivery of a D positive newborn prevents sensitization from up to 15 mL of D positive red blood cells.	Randomized controlled trials <1,2> (I)	There is good evidence to support the recommendation for prenatal and antenatal antibody screening. (A)
Repeat antibody screening test between the 24-28 weeks of gestation if the mother is negative.	Prophylactic administration of 300 ľg of D Ig at 28-29 weeks gestation to unsensitized women further reduces the risks of sensitization.	Non-randomized controlled trials <3-5> (II-1)	There is fair evidence to support the recommendation that additional screening be performed at 24-28 weeks gestation. (B)
Repeat antibody screening before induced abortion, amniocentesis and other obstetrical complications or procedures in which there is the possibility of fetal bleed.	Prophylactic administration of 300 ľg D Ig after induced abortion or amniocentesis (50 ľg if 13 weeks or less) reduces the incidence of sensitization.	Induced abortion: Case series <8,9> (III) Amniocentesis: Non-randomized controlled trial <7> (II-1)	There is fair evidence to support the recommendation that screening be performed with induced abortion and amniocentesis. (B)
	Similar rates of sensitization were found in both intervention and control groups after chorionic villus sampling.	Chorionic Villus Sampling (CVS): Randomized controlled trial <10> (I)	There is poor evidence regarding the inclusion or exclusion of screening with CVS. (C)
	No direct evidence for or against use of D Ig with other obstetric procedures and complications although it may be prudent to administer where the possibility of fetal to maternal bleed is anticipated.	Expert opinion <6,12> (III)	There is poor evidence regarding the inclusion or exclusion of screening for other obstetrical complications, procedures or outcomes. (C)