Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prevention & Management of Rh D Alloimmunization

Obstet Gynecol; ePub 2017 Aug; Silver, et al

The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin that provides evidence-based guidance for the management of patients at risk of Rh D alloimmunization. The routine use of Rh D immune globulin has been responsible for the reduced rate of red cell alloimmunization in more economically developed countries. The new guidance includes updated data to help guide management, especially in regard to weak D phenotype women. The ACOG issued the following (Level A and B) recommendations and conclusions:

  • Prophylactic anti-D immune globulin should be offered to unsensitized Rh D-negative women at 28 weeks of gestation. Following birth, if the infant is confirmed to be Rh D positive, all Rh D-negative women who are not known to be sensitized should receive anti-D immune globulin within 72 hours of delivery (Level A).
  • Administration of Rh D immune globulin is recommended with all invasive diagnostic procedures such as chorionic villus sampling or amniocentesis in Rh D-negative women when the fetuses could be Rh D positive (Level B).


Prevention of Rh D alloimmunization. Practice Bulletin No. 181. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017;130:e57–70.