Rh(D) Incompatibility: Screening

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for Rh(D) incompatibility, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, second edition.¹

Specific Recommendation: The USPSTF strongly recommends Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.

Rationale: The USPSTF found good evidence that Rh(D) blood typing, anti-Rh(D) antibody testing, and intervention with Rh(D) immunoglobulin, as appropriate, prevents maternal sensitization and improves outcomes for newborns. The benefits substantially outweigh any potential harms.

Specific Recommendations: The USPSTF recommends repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative.

Rationale: The USPSTF found fair evidence that repeated antibody testing for unsensitized Rh(D)-negative women (unless the father is also known to be Rh[D]-negative) and intervention with Rh(D) immunoglobulin, as appropriate, provides additional benefit over a single test at the first prenatal visit in preventing maternal sensitization and improving outcomes for newborns. The benefits of repeated testing substantially outweigh any potential harms.

The USPSTF found no new evidence addressing the role of screening, new screening tests, new treatment protocols, or potential harms associated with screening and treatment of Rh(D) incompatibility. However, there is pre-existing good evidence for the efficacy and effectiveness of blood typing, anti-Rh(D) antibody screening, and postpartum Rh(D) immunoglobulin prophylaxis.

The U.S. Preventive Services Task Force (USPSTF) last addressed screening for Rh(D) incompatibility in the 1996 Guide to Clinical Preventive Services and recommended Rh(D) blood typing and antibody screening for all pregnant women at their first prenatal visit (A Recommendation). The USPSTF also recommended repeat antibody screening at 24 to 28 weeks' gestation for unsensitized Rh(D)-negative women (B Recommendation).¹

Since then, the USPSTF criteria to rate the strength of the evidence have changed. Therefore, the recommendation statement that follows has been updated and revised based on the current USPSTF methodology and rating of the strength of the evidence.²

• Administration of a full (300 µg) dose of Rh(D) immunoglobulin is recommended for all unsensitized Rh(D)-negative women after repeated antibody testing at 24 to 28 weeks' gestation.
• If an Rh(D)-positive or weakly Rh(D)-positive (e.g., D^u-positive) infant is delivered, a dose of Rh(D) immunoglobulin should be repeated postpartum, preferably within 72 hours after delivery. Administering Rh(D) immunoglobulin at other intervals after delivery has not been studied.
• Unless the biological father is known to be Rh(D)-negative, a full dose of Rh(D) immunoglobulin is recommended for all unsensitized Rh(D)-negative women after amniocentesis and after induced or spontaneous abortion; however, if the pregnancy is less than 13 weeks, a 50 µg dose is sufficient.
• The benefit of routine administration of Rh(D) immunoglobulin after other obstetric procedures or complications such as chorionic villus sampling, ectopic pregnancy termination, cordocentesis, fetal surgery or manipulation (including external version), antepartum placental hemorrhage, abdominal trauma, antepartum fetal death, or stillbirth is uncertain due to inadequate evidence.

Members of the U.S. Preventive Services Task Force* are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean, School of Nursing, University of Maryland Baltimore, Baltimore, MD); Ned Calonge, M.D., M.P.H. (Acting Chief Medical Officer, Colorado Department of Public Health and Environment, Denver, CO); Paul Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Joxel Garcia, M.D., M.B.A. (Deputy Director, Pan American Health Organization, Washington, DC); Russell Harris, M.D., M.P.H. (Associate Professor of Medicine, Sheps Center for Health Services Research, University of North Carolina School of Medicine, Chapel Hill, NC); Mark S. Johnson, M.D., M.P.H. (Professor of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor, Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY); Carol Loveland-Cherry, Ph.D., R.N. (Executive Associate Dean, School of Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, M.D., M.P.H. (Professor, Department of Pediatrics, University of Texas at Houston, Houston, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, M.D., MSPH (Professor of Medicine, Chief of Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., MSc (Professor of Obstetrics and Gynecology and Professor of Public Health, Columbia University, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor, Department of Family Practice and Department of Preventive and Community Medicine and Director of Research, Department of Family Practice, Virginia Commonwealth University, Fairfax, VA).

* Member of the USPSTF at the time this recommendation was finalized.

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