Management of anti-D prophylaxis in RhD negative women undergoing early medical abortion - an international practice survey among practitioners.

Abstract

Aim: We evaluated the current practices of abortion providers giving anti-D prophylaxis to RhD negative women undergoing first trimester medical abortion and factors that influenced the decision. We also examined RhD management strategies that could be safely adopted.

Methods: A Steering Committee of abortion providers drafted a questionnaire on anti-D prophylaxis practices and perceptions. The 28-question survey, hosted online from December 2022 to December 2023, targeted international abortion providers.

Results: Almost 62% of respondents perform medical abortion during the first trimester (up to 12 weeks of amenorrhoea [WA]), while 32.8% provide it during the second trimester (13 to 26 WA). Among providers, 55.8% administer anti-D prophylaxis to all RhD negative women during first trimester medical abortions, 25.5% provide it selectively, and 18.6% do not administer it at all. Providers who do not administer IgG anti-D rely on national guidelines (51.2%), hospital protocols (16.3%), or both (7.0%), citing early gestational age (36.5%) and insufficient evidence (22.9%) as reasons. The primary reason for administering IgG anti-D was preventing risks in future pregnancies (52.7%). Yet, 59.1% expressed interest in changing their anti-D prophylaxis practices during early abortion.

Conclusion: This study highlights the huge variations in anti-D prophylaxis practices during first trimester medical abortion. These discrepancies mirror differences in national and international guidelines and underscore the need for robust clinical evidence to determine the gestational age limits for alloimmunization risk and support protocol updates.