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Rhesus Incompatibility in Early Medical Abortion up to 8 Weeks of Gestation (Article Review)

Anastasiia Subbotina, Darja Schlothauer, Johanna Löhr, Elvira Nenashkina

Abstract

Introduction: The D Antigen is a specific red blood cell surface protein. Its presence (RhD pos) or absence (RhD neg) is genetically predetermined. In regard to the field of obstetrics, the antigen absence on the mother’s red blood cells is a matter of concern once such a woman becomes pregnant with an RhD pos. fetus as rhesus incompatibility would take place. Once an RhD neg. woman gives birth or undergoes an invasive procedure such as abortion, post-sensitization could happen because D Antigen development takes 35 to 45 days after conception. Even early abortion that takes place up to the 8th week of the pregnancy, involves the risk of unpredictable onset of an alloimmunization process leading to complications in future pregnancies.

Materials and Methods: We have conducted a literature review using database sources including AccessMedicine, PubMed and ScienceDirect. Conflicting evidences were found among a limited number of researches. Consultation with the British Pregnancy Advisory Service took place in order to learn about present practices.

Results: From 2 up to 5 percent of RhD neg. women could produce antibodies as a response to fetal RhD pos. cells entering maternal circulation and not develop alloimmunization reaction in early medical abortion. Small number of studies support that administration of anti-D immunoglobulin (Ig) after abortion leads to decreased alloimmunization development with few side effects. So far, there are no longitudinal studies that would prove the beneficial effect of anti-D Ig administration after early medical abortion. 

Conclusion: The administration of anti-D Ig in RhD neg. women undergoing abortion with RhD pos. fetus is still a subject of debate and demands further investigation. Therefore, doctors have to follow their country guidelines, which vary substantially. For example, the United States suggest prophylactic anti-D administration after 12 weeks of gestation whereas in the United Kingdom it is recommended to give anti-D antigen to every non-sensitized RhD neg. woman after medical abortion regardless of the duration of gestation.


Keywords

rhesus, incompatibility, early, abortion


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