Is the Buddha position beneficial in managing Rh negative pregnancy?

Management of Rh Negative Pregnancy: No Evidence for "Buddha Position"

There is no evidence supporting the use of a "Buddha position" in managing Rh negative pregnancies. The standard of care for Rh negative pregnancies involves RhD immune globulin (RhIg) prophylaxis at appropriate intervals to prevent maternal sensitization and subsequent fetal complications. 1

Standard Management Protocol for Rh Negative Pregnancy

• RhD immune globulin (RhIg) prophylaxis should be administered at 28 weeks gestation and within 72 hours after delivery of an Rh positive infant to prevent maternal sensitization 1
• This two-dose protocol reduces the rate of RhD alloimmunization from approximately 1.8% to between 0.1% and 0.2% 1, 2
• Fetal red blood cells display RhD antigens from as early as 6 weeks of gestation, making maternal sensitization possible even in early pregnancy 3, 1

RhIg Administration for Pregnancy Complications

• For spontaneous and induced abortion at <12 weeks gestation, both RhD testing and RhIg administration should be offered to unsensitized Rh negative individuals 3
• A dose of 50 μg RhIg within 72 hours is adequate for first trimester losses; if unavailable, the standard 300 μg dose should be used 1
• In cases of threatened abortion with heavy bleeding or abdominal pain, RhIg administration is recommended 1
• RhIg should be considered in cases of minor trauma in Rh negative patients, as 28% of pregnant patients with minor trauma have been shown to have fetomaternal hemorrhage 1

Rationale for RhIg Administration

• Prior to the advent of RhIg in the 1970s, hemolytic disease of the newborn led to significant morbidity, long-term disabilities, and mortality 4
• RhD alloimmunization can lead to devastating fetal and neonatal outcomes including hemolytic disease of the fetus/newborn, need for fetal transfusion, fetal hydrops, stillbirth, and preterm delivery 1
• Prevention of alloimmunization is critical given its substantial impact on pregnancy and perinatal outcomes 3
• The risks associated with RhIg administration are low compared to the potential benefits 1

Timing of RhIg Administration

• Universal administration of RhIg at 28 weeks' gestation and postpartum has been shown to reduce the prevalence of Rh immunization by 95.9% 5
• Residual Rh immunization can occur due to small fetal transplacental hemorrhages before antenatal prophylaxis (15%) and significant fetal transplacental hemorrhage between 30 and 38 weeks' gestation (18%) 5
• A clinical trial demonstrated that antenatal administration of RhIg at 28 and 34 weeks' gestation was effective in preventing the development of Rh isoimmunization during pregnancy or within 3 days after delivery 2

Evidence Gaps and Controversies

• Some guidelines, such as those from the Society of Family Planning and World Health Organization, recommend against RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation 3
• However, the Society for Maternal-Fetal Medicine recommends offering both RhD testing and RhIg administration for spontaneous and induced abortion at <12 weeks of gestation due to lack of convincing evidence that it's unnecessary 3
• There is minimal evidence from well-designed research that examines maternal sensitization or hemolytic disease of the newborn as an outcome in patients receiving versus not receiving RhIg in first trimester bleeding 6

Clinical Approach

• Evaluate all Rh-negative pregnant women for appropriate RhIg prophylaxis 1
• Administer RhIg at 28 weeks gestation and within 72 hours after delivery of an Rh positive infant 1
• For bleeding events or pregnancy loss before 12 weeks gestation, administer 50 μg RhIg (or 300 μg if the lower dose is unavailable) 1
• For significant placental trauma, consider quantitative testing for fetomaternal hemorrhage to determine if additional doses are needed 1
• If RhIg supply is limited, prioritize postpartum patients and antenatal patients at later gestational ages 1