NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)
Rhesus-negative sensitisation detected on antenatal screening; the GP recognises the result and refers for specialist monitoring, with anti-D prophylaxis given by obstetric services. - Refer, with advice
Children follow the same pathway: recognise and refer. No primary-care medicine is implied.
No dose - referral pathway, no medicine given in primary care
Rhesus-negative sensitisation detected on antenatal screening; the GP recognises the result and refers for specialist monitoring, with anti-D prophylaxis given by obstetric services.
- A rising antibody level or an ultrasound sign of fetal anaemia is the trigger for a fetal medicine referral. Scottish national guidance asks for referral for fetal assessment once the antibody level reaches the moderate or high risk range (its Table 1, Section 1.3), and for referral to the fetal medicine unit in Glasgow at any stage where ultrasound suggests anaemia - ascites, pleural effusion, hydrops, placentomegaly. Its list of triggers for discussing a woman with that unit also includes an MCA Doppler PSV above 1.5x MoM and ultrasound evidence of fetal anaemia. A rise still matters when the baby has tested antigen negative: where later testing shows the antibody level climbing, the guidance asks that the fetus be considered possibly antigen positive after all.
- No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
- RED FLAG - Severe fetal and neonatal complications of Rh isoimmunisation (hemolysis leading to jaundice, anemia, kernicterus, hydrops fetalis, and potential intrauterine death) are not detailed on the page
- NO ANTI-D DOSE IS PRINTED, AND THAT IS THE SOURCE'S POSITION, NOT AN OMISSION. The cited Rho(D) immune globulin article states that indications vary by manufacturer, that any exposure is dosed according to the amount of red-cell exposure per the manufacturer's guidance, and that dosages are expressed in micrograms or international units on a scale of 1 microgram to 5 international units. It gives no figure of its own, so none is invented here.
- THE TIMING IS THE PART A GP CAN GET WRONG, AND IT IS STATED. The same article gives a single prophylactic dose at 26 to 28 weeks of pregnancy, another within 72 hours of delivering an Rh-positive baby, and repeat dosing every 12 weeks from the first injection to keep enough passive antibody present. Any known or suspected exposure to Rh-positive red cells is also covered within 72 hours.
- WHAT THE 72 HOURS BUYS, in the article's own figures: given within 72 hours of a full-term delivery, sensitisation falls from 12 to 13% down to 1 to 2%; on the 28-week plus postpartum schedule it falls below 1%. If it was missed after delivery, the article says to give it as soon as possible inside those 72 hours.
- TWO PRACTICAL CONSEQUENCES the article names: the patient is watched for at least 20 minutes afterwards for a systemic reaction, and a live vaccine is deferred until at least 12 weeks after the last dose.